Objective. To estimate the likelihood of occult cancer diagnosis at prophylactic oophorectomy in BRCA1 and BRCA2 carriers in different age groups and to determine the histopathology of these lesions. Methods. We descr...Objective. To estimate the likelihood of occult cancer diagnosis at prophylactic oophorectomy in BRCA1 and BRCA2 carriers in different age groups and to determine the histopathology of these lesions. Methods. We describe a series of 159 female BRCA1 or BRCA2 carriers who underwent prophylactic oophorectomy at the University Health Network, Toronto from January 1, 1992 to June 30, 2004. Results. Seven (4.4% ) occult cancers were detected at pathologic examination. None of the 159 subjects had clinical signs or symptoms of ovarian carcinoma prior to, or at the time of, surgery. Only two cancers were grossly visible at surgery. There were 94 BRCA1 carriers, of whom six were found to have an occult cancer (6.4% ). In contrast, only one of the 65 BRCA2 carriers was found to have an occult cancer (1.5% ). Three of the seven cases of occult malignancy involved the fallopian tube and not the ovaries. Conclusion. Approximately 6% of BRCA1 carriers and 2% of BRCA2 carriers who undergo prophylactic salpingo- oophorectomy will be found to have occult carcinomas if the ovaries and tubes are rigorously examined. A significant proportion of these appear to originate in the fallopian tube. No cancers were detected among women who had the operation at age 39 or younger.展开更多
Objective: To assess the effectiveness of a policy of performing a vaginal hysterectomy for as many cases of dysfunctional uterine bleeding without uterine prolapse as possible between 1997 and 2003. Study design: The...Objective: To assess the effectiveness of a policy of performing a vaginal hysterectomy for as many cases of dysfunctional uterine bleeding without uterine prolapse as possible between 1997 and 2003. Study design: The study was prospective, with retrospective analysis of data. Setting: Warwick Hospital. Population: Eighty-seven women in a district hospital serving a population of 270,000 in South Warwick shire. Methods: During 1997 and 2003, an effort was made to perform as many hysterectomies vaginally as possible, with oophorectomy where necessary, in women with dysfunctional uterine bleeding in the absence of prolapse. The trends of the three different operations, total abdominal hysterectomy, sub-total abdominal hysterectomy and vaginal hysterectomy over the 7- year period were analysed. Main outcome measures: The ability to undertake surgery successfully, complications rates, length of hospital stay and changes in surgical practice. Results: Over this 7- year period, it has proved possible to change the emphasis from abdominal to vaginal hysterectomy for dysfunctional uterine bleeding. In 1997, the most common operation for dysfunctional uterine bleeding (72.7% ) was subtotal hysterectomy ± bilateral salpingo-oophorectomy, followed by (27.3% ) total abdominal hysterectomy ± bilateral salpingo-oophorectomy. No cases were undertaken vaginally. By 2003, however, the trend had completely reversed, with the only procedure undertaken being vaginal hysterectomy ± bilateral salpingooophorectomy. There is no evidence that such an approach increases the complication rate, and the recovery rate from surgery is improved with a tendency towards earlier discharge in the vaginal surgery group. Conclusion: The vaginal approach is possible for an average gynaecologist working in a district general hospital, with no additional complications and an improved recovery rate for patients.展开更多
Objective: To present a case of a unicornuate uterus with ipsilateral ovarian and renal agenesis. Design: Case report. Setting: Baskent University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, T...Objective: To present a case of a unicornuate uterus with ipsilateral ovarian and renal agenesis. Design: Case report. Setting: Baskent University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey. Patient(s): A 48- year- old gravida 3 (para 3 with term deliveries) woman with a 6- month history of menometrorrhagia was admitted to our clinic. Our diagnosis was a pedunculated submucous leiomyoma that protruded into the vagina. Intervention(s): The patient chose to have a total abdominal hysterectomy and unilateral salpingoopherectomy. Main Outcome Measure(s): During laparotomy, a unicornuate uterus with a noncommunicating horn, together with ipsilateral ovarian agenesis, was observed. A total abdominal hysterectomy and unilateral salpingoopherectomy were performed successfully. Because we could not detect the left ovary and left ureter during the operation, we planned an abdominal ultrasonography and intravenous pyelography (IVP) postoperatively to demonstrate possible urinary tract abnormalities. Result(s): We detected left renal agenesis by IVP. Conclusion(s): We presented a very rare clinical condition that demonstrates a unicornuate uterus with a noncommunicating horn, and ipsilateral ovarian and renal agenesis concomitantly. The absence of one ovary and one kidney in our case may be explained by the abnormal development of organs derived from a unilateral urogenital ridge.展开更多
Background. A pilot study was undertaken to determine the feasibility of examining a COX- 2 inhibitor (Celecoxib) as a chemopreventive agent in women at increased risk of ovarian cancer undergoing risk reducing salpin...Background. A pilot study was undertaken to determine the feasibility of examining a COX- 2 inhibitor (Celecoxib) as a chemopreventive agent in women at increased risk of ovarian cancer undergoing risk reducing salpingoophorectomy. Methods. Women at elevated inherited risk of ovarian carcinoma pursuing risk reducing salpingoophorectomy were eligible for this trial. Ten patients were assigned to a control group while 10 patients were administered Celecoxib (400 mg/day) for 3 months prior to surgery. Demographic data at enrollment was collected. Serum, urine, peritoneal fluid, and resected tissues were obtained for correlative laboratory study. Evaluation of serum VEGF alterations was examined using an ELISA- based assay. Results. Enrollment of patients was completed in 16 months. Of 29 eligible patients, 20 enrolled onto the study. One patient from each group did not complete surgical intervention. No significant differences were observed in the enrollment characteristics between the groups. No occult cases of ovarian cancer were identified and no differences in the presence of follicular cyst, hemorrhagic cysts, or inclusion cysts were noted on initial pathologic review. While the mean serum VEGF levels obtained following the administration of a COX- 2 inhibitor were lower than the pre-administration in 5 of 6 patients, statistical significance in this difference was not observed (P=0.359). However, this is most likely due to the small number of serum samples available. Conclusion. These results would suggest that chemoprevention trials in ovarian cancer will be eagerly embraced by this patient population.展开更多
文摘Objective. To estimate the likelihood of occult cancer diagnosis at prophylactic oophorectomy in BRCA1 and BRCA2 carriers in different age groups and to determine the histopathology of these lesions. Methods. We describe a series of 159 female BRCA1 or BRCA2 carriers who underwent prophylactic oophorectomy at the University Health Network, Toronto from January 1, 1992 to June 30, 2004. Results. Seven (4.4% ) occult cancers were detected at pathologic examination. None of the 159 subjects had clinical signs or symptoms of ovarian carcinoma prior to, or at the time of, surgery. Only two cancers were grossly visible at surgery. There were 94 BRCA1 carriers, of whom six were found to have an occult cancer (6.4% ). In contrast, only one of the 65 BRCA2 carriers was found to have an occult cancer (1.5% ). Three of the seven cases of occult malignancy involved the fallopian tube and not the ovaries. Conclusion. Approximately 6% of BRCA1 carriers and 2% of BRCA2 carriers who undergo prophylactic salpingo- oophorectomy will be found to have occult carcinomas if the ovaries and tubes are rigorously examined. A significant proportion of these appear to originate in the fallopian tube. No cancers were detected among women who had the operation at age 39 or younger.
文摘Objective: To assess the effectiveness of a policy of performing a vaginal hysterectomy for as many cases of dysfunctional uterine bleeding without uterine prolapse as possible between 1997 and 2003. Study design: The study was prospective, with retrospective analysis of data. Setting: Warwick Hospital. Population: Eighty-seven women in a district hospital serving a population of 270,000 in South Warwick shire. Methods: During 1997 and 2003, an effort was made to perform as many hysterectomies vaginally as possible, with oophorectomy where necessary, in women with dysfunctional uterine bleeding in the absence of prolapse. The trends of the three different operations, total abdominal hysterectomy, sub-total abdominal hysterectomy and vaginal hysterectomy over the 7- year period were analysed. Main outcome measures: The ability to undertake surgery successfully, complications rates, length of hospital stay and changes in surgical practice. Results: Over this 7- year period, it has proved possible to change the emphasis from abdominal to vaginal hysterectomy for dysfunctional uterine bleeding. In 1997, the most common operation for dysfunctional uterine bleeding (72.7% ) was subtotal hysterectomy ± bilateral salpingo-oophorectomy, followed by (27.3% ) total abdominal hysterectomy ± bilateral salpingo-oophorectomy. No cases were undertaken vaginally. By 2003, however, the trend had completely reversed, with the only procedure undertaken being vaginal hysterectomy ± bilateral salpingooophorectomy. There is no evidence that such an approach increases the complication rate, and the recovery rate from surgery is improved with a tendency towards earlier discharge in the vaginal surgery group. Conclusion: The vaginal approach is possible for an average gynaecologist working in a district general hospital, with no additional complications and an improved recovery rate for patients.
文摘Objective: To present a case of a unicornuate uterus with ipsilateral ovarian and renal agenesis. Design: Case report. Setting: Baskent University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey. Patient(s): A 48- year- old gravida 3 (para 3 with term deliveries) woman with a 6- month history of menometrorrhagia was admitted to our clinic. Our diagnosis was a pedunculated submucous leiomyoma that protruded into the vagina. Intervention(s): The patient chose to have a total abdominal hysterectomy and unilateral salpingoopherectomy. Main Outcome Measure(s): During laparotomy, a unicornuate uterus with a noncommunicating horn, together with ipsilateral ovarian agenesis, was observed. A total abdominal hysterectomy and unilateral salpingoopherectomy were performed successfully. Because we could not detect the left ovary and left ureter during the operation, we planned an abdominal ultrasonography and intravenous pyelography (IVP) postoperatively to demonstrate possible urinary tract abnormalities. Result(s): We detected left renal agenesis by IVP. Conclusion(s): We presented a very rare clinical condition that demonstrates a unicornuate uterus with a noncommunicating horn, and ipsilateral ovarian and renal agenesis concomitantly. The absence of one ovary and one kidney in our case may be explained by the abnormal development of organs derived from a unilateral urogenital ridge.
文摘Background. A pilot study was undertaken to determine the feasibility of examining a COX- 2 inhibitor (Celecoxib) as a chemopreventive agent in women at increased risk of ovarian cancer undergoing risk reducing salpingoophorectomy. Methods. Women at elevated inherited risk of ovarian carcinoma pursuing risk reducing salpingoophorectomy were eligible for this trial. Ten patients were assigned to a control group while 10 patients were administered Celecoxib (400 mg/day) for 3 months prior to surgery. Demographic data at enrollment was collected. Serum, urine, peritoneal fluid, and resected tissues were obtained for correlative laboratory study. Evaluation of serum VEGF alterations was examined using an ELISA- based assay. Results. Enrollment of patients was completed in 16 months. Of 29 eligible patients, 20 enrolled onto the study. One patient from each group did not complete surgical intervention. No significant differences were observed in the enrollment characteristics between the groups. No occult cases of ovarian cancer were identified and no differences in the presence of follicular cyst, hemorrhagic cysts, or inclusion cysts were noted on initial pathologic review. While the mean serum VEGF levels obtained following the administration of a COX- 2 inhibitor were lower than the pre-administration in 5 of 6 patients, statistical significance in this difference was not observed (P=0.359). However, this is most likely due to the small number of serum samples available. Conclusion. These results would suggest that chemoprevention trials in ovarian cancer will be eagerly embraced by this patient population.
