Is There Re-staging Surgery Necessity for Borderline Ovarian Tumors

Objective:This study assessed the necessity of surgical re-staging in women with borderline ovarian tumors(BOTs)and evaluated the impact of complete surgical staging,lymphadenectomy,and omentectomy on disease recurrence and survival.Methods:We retrospectively reviewed the medical records of patients with BOTs.A total of 901 patients were eligible for inclusion in the study,and we evaluated some of the variables and clinical/surgical characteristics of the cases.The effects of the type of surgical procedure,surgical staging,and complete or incomplete staging on recurrence were calculated.The rates of disease-free survival,overall survival,and recurrence were compared according to complete surgical staging.A Cox regression analysis was performed to identify potential prognostic factors,and survival curves were constructed using the Kaplan-Meier method.Results:The overall recurrence rate was 13.9%,and recurrence was comparable between the complete surgical staging group and the incomplete groups(P>0.05).The performance of complete surgical staging did not show an effect on long-term survival,and complete surgical staging,omentectomy,and lymphadenectomy had no effect on recurrence.In multivariate analyses,only radical surgery and adjuvant chemotherapy were risk factors for the recurrence of BOTs.Furthermore,we found that omentectomy led to a relatively low recurrence rate in patients with International Federation of Gynecology and Obstetrics(FIGO)stage>Ⅰ(P=0.022).Conclusion:Our results suggest that complete surgical staging should be considered a standard treatment for patients with advanced stage BOTs but not for those at FIGO stageⅠ.It might be safe to reduce the scope of surgical procedures in patients with early-stage BOTs.However,it is not necessary to perform re-staging operations for BOTs with a macroscopically normal extra-ovarian appearance.

Staged lensectomy and vitrectomy in the management of stage 5C retinopathy of prematurity with corneal opacification:long-term follow up

·AIM:To verify the feasibility and safety of staged lensectomy and vitrectomy in stage 5 C retinopathy of prematurity(ROP)with corneal opacification.·METHODS:This was a retrospective,interventional,consecutive case series.Twenty-two eyes of 18 stage 5 C ROP patients with corneal opacification were included.Regular combined lensectomy and vitrectomy were not prescribed due to the invisible fundus.Staged lensectomy and posterior vitrectomy were performed.The anatomical and visual outcomes were reviewed at the final follow-up visit.·RESULTS:The mean gestational age of ROP patients was29.3±1.6 wk(range:27-32 wk),comprising 8 males and 10 females.The average birth weight was 1363.0±300.0 g.All the eyes had corneal opacity and flat or disappeared anterior chambers pre-operatively.Two eyes had complicated cataract and 7 eyes had retrolental fibroplasia.Six eyes had posterior pupillary synechiae or membranes.Seven(31.8%)eyes had vascularly active retinas.The average interval between two procedures was 6.8±4.6 mo(2.5-18.5 mo).After surgeries,all the patients had normal anterior chambers.Fourteen eyes had clear corneas.The intraocular pressure of 3 eyes with glaucoma was controlled by medication.Two eyes had ocular phthisis.The retina was reattached in 3 eyes and partially attached in 11 eyes.Visual acuity ranged from no light perception to hand motion.·CONCLUSION:Staged lensectomy and vitrectomy are procedures that can halt progression to further complications and preserve some useful eyesight in stage5 C ROP patients with corneal opacification.The earlier the lensectomy is performed,the better the prognosis is.

Development of perianal ulcer as a result of acute fulminant amoebic colitis

We report a case of acute fulminant amoebic colitis that resulted in the development of a perianal ulcer in a 29-year-old Japanese homosexual man with acquired immunodeficiency syndrome (AIDS). The patient was admitted to our hospital with a persistent perianal abscess that was refractory to antibiotic therapy adminis-tered at another hospital. On admission, we observed a giant ulcer in the perianal region. At first, cytomega-lovirus colitis was suspected by blood investigations. Ganciclovir therapy was initiated; however, the patient developed necrosis of the skin around the anus during therapy. We only performed end-sigmoidostomy and necrotomy to avoid excessive surgical invasion. Histopathological examination of the surgical specimen revealed the presence of trophozoite amoebae, indicating a final diagnosis of acute fulminant amoebic colitis. The patient's postoperative course was favorable, and proctectomy of the residual rectum was performed 11 mo later. Amoebic colitis is one of the most severe complications affecting patients with AIDS. Particularly, acute fulminant amoebic colitis may result in a poor prognosis; therefore, staged surgical therapy as a lessinvasive procedure should be considered as one of the treatment options for these patients.

Staging surgery for intraventricular bilateral giant Rosai–Dorfman disease in children

Introduction:Rosai-Dorfman disease(RDD)is an uncommon,benign,and idiopathic histiocytic proliferative disorder.Multiple intracranial RDD is extremely rare and treatment varies.Case presentation:A 9-year-old girl was admitted with 3-month history of blurred vision and facial paralysis,a 2-month history of recurrent giggle,and cognitive impairment.Computed tomography and magnetic resonance imaging scans revealed bilateral ventricular masses based on the dural membrane and the diameters of the masses were 9.1 cm and 9.2 cm,respectively.The lesions were completely removed with staging surgeries.Fifteen months after operation,blurred vision was still present but facial paralysis and giggle and cognitive impairment disappeared.Imaging examinations suggested that there were no new or recurring lesions.Conclusion:For multiple large intracranial masses,surgical treatment is necessary and staged surgery benefits perioperative safety.Active follow-up with magnetic resonance imaging is necessary.