. The aim of this study was to evaluate the impact of the surgical approach on the management and outcomes of patients with early borderline ovarian tumors (BOTs). Material and methods. We retrospectively reviewed the.... The aim of this study was to evaluate the impact of the surgical approach on the management and outcomes of patients with early borderline ovarian tumors (BOTs). Material and methods. We retrospectively reviewed the medical charts of patients with stage Ia to Ic BOT treated surgically between January 1, 1985, and December 31, 2001. We compared patients initially managed by laparoscopy vs laparotomy in terms of potentially harmful procedures and quality of staging. Results. Of the 118 included patients, 48 (41% ) had laparoscopy for initial surgery, 54 (45% ) had laparotomy, and 16 (14% ) had conversion from laparoscopy to laparotomy. Conservative treatment (57% of patients) was more common with laparoscopy (vs laparotomy, P < 0.05) and in women older than 44 years (vs younger than 44 years, P < 0.001). Intraoperative tumor rupture occurred in 9% of patients and was not associated with the surgical approach (P = 0.1). Bag extraction was used in 19 (40% ) of the 48 laparoscopy patients. Staging was incomplete in 73% of patients overall. By univariate analysis, better quality of staging was associated with bilateral adnexectomy, age >44 years, laparotomy, hysterectomy, and treatment after 1995. By multivariate analysis, bilateral adnexectomy or hysterectomy was associated with better staging. Mean follow-up was 40 months, during which recurrence and survival rates were similar in the laparoscopy and laparotomy groups. Conclusion. Staging of macroscopic early stage BOTs was better in patients requiring radical surgery. After adjustment on disease severity, type of surgical access was not related to staging quality.展开更多
Objectives The purpose of this research was to study long term left ventricul ar(LV) adaptations in very high level endurance athletes. Background Knowledge of cardiac changes in athletes, who are at particularly high...Objectives The purpose of this research was to study long term left ventricul ar(LV) adaptations in very high level endurance athletes. Background Knowledge of cardiac changes in athletes, who are at particularly high risk of sudden car diac death, is mandatory to detect hypertrophic cardiomyopathy (HCM) or dilated (DCM) cardiomyopathy. Methods We carried out echocardiographic examinations on 2 86 cyclists(group A) and 52 matched sedentary volunteers (group C); 148 cyclists participated in the 1995 “Tour de France”race (group A1), 138 in the 1998 rac e (group A2), and 37 in both (group B). Results In groups A, A1, A2, and C, resp ectively, diastolic left ventricular diameter (LVID)was 60.1±3.9 mm, 59.2±3.8 mm, 61.0±3.9 mm, and 49.0 ±4.3 mm (A vs. C and A1 vs. A2, p< 0.0001), and maxi mal wall thickness (WT) was 11.1 ±1.3 mm, 11.6 ±1.3 mm, 10.6 ±1.1 mm, and 8.6 ±1.0 mm (A vs. C and A1 vs. A2, p< 0.0001). Among group A, 147 (51.4%) had LV ID >60 mm; 17 of them had also a below normal (< 52%) left ventricular ejection fraction (LVEF). Wall thickness exceeded 13 mm in 25 athletes (8.7%) (always< 15 mm), 23 with LVID >55 mm. In group B, LVID increased (58.3 ±4.8 mm to 60.3 ±4.2 mm, p< 0.001) and WT decreased (11.8 ±1.2 mm to 10.8 ±1.2 mm, p< 0.001) with time. Conclusions Over one half of these athletes exhibited unusual LV dil ation, along with a reduced LVEF in 11.6%(17 of 147), compatible with the diagn osis of DCM. Increased WT was less common (always <15 mm) and scarce without LV dilation (< 1%), eliminating the diagnosis of HCM. Serial examinations showed evidence of furth er LV dilation along with wall thinning. These results might have important impl ications for screening in athletes.展开更多
文摘. The aim of this study was to evaluate the impact of the surgical approach on the management and outcomes of patients with early borderline ovarian tumors (BOTs). Material and methods. We retrospectively reviewed the medical charts of patients with stage Ia to Ic BOT treated surgically between January 1, 1985, and December 31, 2001. We compared patients initially managed by laparoscopy vs laparotomy in terms of potentially harmful procedures and quality of staging. Results. Of the 118 included patients, 48 (41% ) had laparoscopy for initial surgery, 54 (45% ) had laparotomy, and 16 (14% ) had conversion from laparoscopy to laparotomy. Conservative treatment (57% of patients) was more common with laparoscopy (vs laparotomy, P < 0.05) and in women older than 44 years (vs younger than 44 years, P < 0.001). Intraoperative tumor rupture occurred in 9% of patients and was not associated with the surgical approach (P = 0.1). Bag extraction was used in 19 (40% ) of the 48 laparoscopy patients. Staging was incomplete in 73% of patients overall. By univariate analysis, better quality of staging was associated with bilateral adnexectomy, age >44 years, laparotomy, hysterectomy, and treatment after 1995. By multivariate analysis, bilateral adnexectomy or hysterectomy was associated with better staging. Mean follow-up was 40 months, during which recurrence and survival rates were similar in the laparoscopy and laparotomy groups. Conclusion. Staging of macroscopic early stage BOTs was better in patients requiring radical surgery. After adjustment on disease severity, type of surgical access was not related to staging quality.
文摘Objectives The purpose of this research was to study long term left ventricul ar(LV) adaptations in very high level endurance athletes. Background Knowledge of cardiac changes in athletes, who are at particularly high risk of sudden car diac death, is mandatory to detect hypertrophic cardiomyopathy (HCM) or dilated (DCM) cardiomyopathy. Methods We carried out echocardiographic examinations on 2 86 cyclists(group A) and 52 matched sedentary volunteers (group C); 148 cyclists participated in the 1995 “Tour de France”race (group A1), 138 in the 1998 rac e (group A2), and 37 in both (group B). Results In groups A, A1, A2, and C, resp ectively, diastolic left ventricular diameter (LVID)was 60.1±3.9 mm, 59.2±3.8 mm, 61.0±3.9 mm, and 49.0 ±4.3 mm (A vs. C and A1 vs. A2, p< 0.0001), and maxi mal wall thickness (WT) was 11.1 ±1.3 mm, 11.6 ±1.3 mm, 10.6 ±1.1 mm, and 8.6 ±1.0 mm (A vs. C and A1 vs. A2, p< 0.0001). Among group A, 147 (51.4%) had LV ID >60 mm; 17 of them had also a below normal (< 52%) left ventricular ejection fraction (LVEF). Wall thickness exceeded 13 mm in 25 athletes (8.7%) (always< 15 mm), 23 with LVID >55 mm. In group B, LVID increased (58.3 ±4.8 mm to 60.3 ±4.2 mm, p< 0.001) and WT decreased (11.8 ±1.2 mm to 10.8 ±1.2 mm, p< 0.001) with time. Conclusions Over one half of these athletes exhibited unusual LV dil ation, along with a reduced LVEF in 11.6%(17 of 147), compatible with the diagn osis of DCM. Increased WT was less common (always <15 mm) and scarce without LV dilation (< 1%), eliminating the diagnosis of HCM. Serial examinations showed evidence of furth er LV dilation along with wall thinning. These results might have important impl ications for screening in athletes.
