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  1 / 1429 MEDLINE  
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PMID:29229147
Autor:Pyter LM; McKim DB; Husain Y; Calero H; Godbout JP; Sheridan JF; Marucha PT; Engeland CG
Endereço:Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, Ohio; Departments of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio; Department of Neuroscience, Ohio State University, Columbus, Ohio; Center for Wound Healing and Tissue Rege
Título:Effects of dermal wounding on distal primary tumor immunobiology in mice.
Fonte:J Surg Res; 221:328-335, 2018 Jan.
ISSN:1095-8673
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Before primary oral tumors are treated, various prophylactic procedures that require tissue repair are often necessary (e.g. biopsies, tooth extractions, radiation, and tracheotomies). Wound healing and tumor growth harness similar immune/inflammatory mechanisms. Our previous work indicates that tumors impair wound healing, although the extent to which tissue repair conversely influences tumor growth is poorly understood. Here, we test the hypothesis that dermal wound healing exacerbates primary tumor growth and influences tumor immunobiology. MATERIALS AND METHODS: Female, immunocompetent mice were inoculated subcutaneously with murine oral cancer cells (AT-84) to induce flank tumors. Half of the mice received dermal excisional wounds (4 × 3.5 mm diameter) on their dorsum 16 days later, whereas the skin of controls remained intact. Tumor and blood tissues were harvested 1 and 5 days post wounding, and tumor myeloid cell populations and inflammatory gene expression were measured. Circulating myeloid cells, cytokines, and corticosterone were also quantified. RESULTS: Wounding increased tumor mass, early tumor infiltration of macrophages, and tumor inflammatory gene expression. While wounding attenuated tumor growth-induced increases in circulating myeloid cells, no effects of wounding on circulating cytokine/endocrine measures were observed. CONCLUSIONS: These results indicate that modest skin immune/inflammatory processes can enhance distal tumor growth and alter innate tumor immunity. The implication for this work is that, in the presence of a tumor, the benefits of tissue-damaging procedures that occur clinically must be weighed against the potential consequences for tumor biology.
Tipo de publicação: JOURNAL ARTICLE


  2 / 1429 MEDLINE  
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PMID:28645428
Autor:van de Vrie R; van Meurs HS; Rutten MJ; Naaktgeboren CA; Opmeer BC; Gaarenstroom KN; van Gorp T; Ter Brugge HG; Hofhuis W; Schreuder HWR; Arts HJG; Zusterzeel PLM; Pijnenborg JMA; van Haaften M; Engelen MJA; Boss EA; Vos MC; Gerestein KG; Schutter EMJ; Kenter GG; Bossuyt PMM; Mol BW; Buist MR
Endereço:Department of Gynecology, Center for Gynecologic Oncology Amsterdam, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
Título:Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer.
Fonte:Gynecol Oncol; 146(3):449-456, 2017 Sep.
ISSN:1095-6859
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVE: To evaluate the cost-effectiveness of a diagnostic laparoscopy prior to primary cytoreductive surgery to prevent futile primary cytoreductive surgery (i.e. leaving >1cm residual disease) in patients suspected of advanced stage ovarian cancer. METHODS: An economic analysis was conducted alongside a randomized controlled trial in which patients suspected of advanced stage ovarian cancer who qualified for primary cytoreductive surgery were randomized to either laparoscopy or primary cytoreductive surgery. Direct medical costs from a health care perspective over a 6-month time horizon were analyzed. Health outcomes were expressed in quality-adjusted life-years (QALYs) and utility was based on patient's response to the EQ-5D questionnaires. We primarily focused on direct medical costs based on Dutch standard prices. RESULTS: We studied 201 patients, of whom 102 were randomized to laparoscopy and 99 to primary cytoreductive surgery. No significant difference in QALYs (utility=0.01; 95% CI 0.006 to 0.02) was observed. Laparoscopy reduced the number of futile laparotomies from 39% to 10%, while its costs were € 1400 per intervention, making the overall costs of both strategies comparable (difference € -80 per patient (95% CI -470 to 300)). Findings were consistent across various sensitivity analyses. CONCLUSION: In patients with suspected advanced stage ovarian cancer, a diagnostic laparoscopy reduced the number of futile laparotomies, without increasing total direct medical health care costs, or adversely affecting complications or quality of life.
Tipo de publicação: JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL


  3 / 1429 MEDLINE  
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PMID:27690703
Autor:Bove GM; Chapelle SL; Boyle E; Mokler DJ; Hartvigsen J
Endereço:a Department of Biomedical Sciences , University of New England College of Osteopathic Medicine , Biddeford , ME , USA.
Título:A Novel Method for Evaluating Postoperative Adhesions in Rats.
Fonte:J Invest Surg; 30(2):88-94, 2017 Apr.
ISSN:1521-0553
País de publicação:England
Idioma:eng
Resumo:Purpose/Aim: Postoperative adhesions remain an undesirable and commonly symptomatic side effect of abdominopelvic surgeries. Animal models of postoperative adhesions typically yield heterogeneous adhesions throughout the abdominal cavity and are not easily quantified. Here we present a novel method of postoperative adhesion assessment and report its reliability and measurement error. MATERIALS AND METHODS: A model of cecal abrasion with partial sidewall attachment was performed on female rats. After 1, 2, 4, or 7 days of recovery, the rats were euthanized and their abdominopelvic cavities were systematically evaluated for postoperative adhesions. The necropsy was recorded through the surgical microscope. Four raters were trained to use a ballot to capture key factors of the adhesions as they viewed the recordings. Their ratings were compared for measurement error and reliability (using Bland-Altman plots and intraclass correlation coefficients, respectively) and for the ability to discriminate differences in experimental groups. A subset of the data was analyzed to determine practical utility. RESULTS: The rating system was shown to have low measurement error and high inter-rater reliability for all parameters measured. Applied practically, the system was able to discriminate groups in a manner that was expected. CONCLUSIONS: We have developed and validated a rating system for postoperative adhesions and shown that it can detect group differences. This method can be used to quantify postoperative adhesions in rodent models.
Tipo de publicação: JOURNAL ARTICLE; VALIDATION STUDIES
Nome de substância:0 (Biocompatible Materials)


  4 / 1429 MEDLINE  
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PMID:27873763
Autor:Konik E; Geske J; Edwards W; Gersh B
Endereço:Department of Medicine/Cardiology, Mayo Clinic, Rochester, Minnesota, USA.
Título:Pericardiectomy as a diagnostic and therapeutic procedure.
Fonte:BMJ Case Rep; 2016, 2016 Nov 14.
ISSN:1757-790X
País de publicação:England
Idioma:eng
Resumo:A 70-year-old man presented with recent onset, predominantly right-sided heart failure. Echocardiogram demonstrated features of hypertensive heart disease and was suggestive of, but non-diagnostic for, constrictive pericarditis (CP). CT demonstrated mild pericardial thickening. Right heart catheterisation showed elevation and equalisation of diastolic pressures in all cardiac chambers with early rapid filling, minimal ventricular interdependence, and no dissociation of intrathoracic and intracardiac pressures. While several features pointed towards CP, the minimal ventricular interdependence and no dissociation of intrathoracic and intracardiac pressures suggested other pathology. Diagnostic pericardiectomy was performed, after which the central venous pressure decreased from 22 to 12 mm Hg. Pathology revealed pericardial fibrosis. The patient experienced sustained resolution of his heart failure. A potential explanation for lack of CP criteria was the presence of hypertensive heart disease. CP needs to be considered when approaching patients with heart failure as diagnostic evaluation can be multifaceted and treatment curative.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE


  5 / 1429 MEDLINE  
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PMID:27467856
Autor:Burgmeier C; Leriche C
Endereço:Department of General and Pediatric Surgery, University Medical Center Ulm , Ulm, Germany .
Título:Laparoscopy in the Surgical Treatment of Disorders of Sexual Development.
Fonte:J Laparoendosc Adv Surg Tech A; 26(9):730-3, 2016 Sep.
ISSN:1557-9034
País de publicação:United States
Idioma:eng
Resumo:INTRODUCTION: Disorder of sexual development (DSD) is a rare condition. The surgical treatment of these patients includes investigation of the internal genitalia, evaluation of the gonads, and if necessary gonadectomy. The prevention of germ cell tumors is the most important issue in the surgical treatment of this varied and special group of patients. This study aimed to evaluate the role of laparoscopy in the surgical treatment of patients with DSD. MATERIALS AND METHODS: Over a 4-year-period, all patients presenting with DSD who underwent laparoscopic surgery at our institution were retrospectively reviewed. Operative procedure, age at the time of surgery, and histopathological results were evaluated. In addition, karyotypes and phenotypes were investigated. RESULTS: Altogether, 12 patients undergoing 14 laparoscopic procedures were included. Median age at the time of surgery was 6 years with a range from 9 months to 17 years. Explorative laparoscopy was performed in all patients. In seven children, laparoscopic gonadectomy was necessary. Histopathologic examination revealed germ cell tumors in four children. In two patients, a gonadoblastoma was identified; in two patients, a dysgerminoma was found. Inguinal exploration was performed in four patients and led to removal of gonadal remnants in one case and gonadopexy in three cases. In two patients presenting with repeated urinary tract infections, laparoscopic removal of an utriculus was performed. CONCLUSIONS: Laparoscopic gonadal biopsy, gonadopexy, and gonadectomy can be performed successfully, even in patients with germ cell tumors. To define guidelines for the surgical treatment of patients with DSD, further prospective and multicenter studies are necessary.
Tipo de publicação: JOURNAL ARTICLE


  6 / 1429 MEDLINE  
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PMID:27464602
Autor:Menakaya UA; Rombauts L; Johnson NP
Endereço:Department of Obstetrics and Gynecology, Calvary Public Hospital, ACT, Australia. info@junicimaging.com.au.
Título:Diagnostic laparoscopy in pre-surgical planning for higher stage endometriosis: Is it still relevant?
Fonte:Aust N Z J Obstet Gynaecol; 56(5):518-522, 2016 Oct.
ISSN:1479-828X
País de publicação:Australia
Idioma:eng
Resumo:It has become necessary to re - examine the relevance of diagnostic laparoscopy in the two-stage approach to surgical management of symptomatic women with higher stage endometriosis following emerging evidence demonstrating acceptable diagnostic performance of alternative less invasive and less expensive imaging modalities. We highlight the relative merits of these presurgical diagnostic imaging modalities and propose strategies that address the challenge of transitioning to a new diagnostic paradigm in the management of symptomatic women with higher stage endometriosis.
Tipo de publicação: JOURNAL ARTICLE


  7 / 1429 MEDLINE  
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PMID:27135780
Autor:Zhao T; Zhang H; Liu Y; Jiang H; Wang X; Lu Y
Endereço:Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Título:The role of staging surgery in the treatment of apparent early-stage malignant ovarian germ cell tumours.
Fonte:Aust N Z J Obstet Gynaecol; 56(4):398-402, 2016 Aug.
ISSN:1479-828X
País de publicação:Australia
Idioma:eng
Resumo:BACKGROUND: Malignant ovarian germ cell tumours (MOGCTs) are usually detected at an early stage, with patients achieving a satisfactory prognosis. However, the role of staging surgery in the treatment of apparent early-stage MOGCTs remains controversial. AIMS: To investigate the role of staging procedures in apparent early-stage patients. MATERIALS AND METHODS: We performed a retrospective review of 102 patients who were diagnosed with MOGCTs and had malignant lesions confined to their ovaries, between January 1997 and October 2014 at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. Statistical analysis was carried out using SPSS software which included survival analysis by Kaplan-Meier method and Fisher's exact test. RESULTS: Three patients relapsed and one died. The five-year overall survival rate and disease-free survival rate were 98.7% and 96.4%, respectively. Eighty-nine patients (87.3%) received adjuvant chemotherapy and only 23 patients (22.5%) were completely staged. In total, 3/49 (6.1%), 1/44 (2.3%) and 0/49 (0.0%) patients were diagnosed with malignant cells in peritoneal fluid, pelvic lymph nodes and omentum, respectively. Positive tumour cells were not correlated with recurrence. Univariate analysis revealed that neither complete staging surgery nor individual factors were useful prognostic factors for disease-free survival. CONCLUSIONS: The staging surgery could be omitted for apparent early-stage patients affected by MOGCTs without adverse impact upon survival.
Tipo de publicação: JOURNAL ARTICLE


  8 / 1429 MEDLINE  
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PMID:27050811
Autor:Mut T; Acar Ö; Oktar T; Kiliçaslan I; Esen T; Ander H; Ziylan O
Endereço:Department of Urology, VKF Amerikan Hospital, Istanbul, Turkey. Electronic address: tunamut@hotmail.com.
Título:Intraoperative inspection of the ureteropelvic junction during pyeloplasty is not sufficient to distinguish between extrinsic and intrinsic causes of obstruction: Correlation with histological analysis.
Fonte:J Pediatr Urol; 12(4):223.e1-6, 2016 Aug.
ISSN:1873-4898
País de publicação:England
Idioma:eng
Resumo:INTRODUCTION: Based on current knowledge, it is possible to have an initial diagnosis of intrinsic or extrinsic ureteropelvic junction obstruction (UPJO) based solely on clinical and imaging findings. However, it may not be possible to strictly discriminate an intrinsic case with an additional extrinsic component from a primarily intrinsic stenosis because of lower pole aberrant vessels. These two disorders may coexist or trigger each other. Herein, we aimed to compare the histological changes observed in intrinsic and extrinsic types of UPJO. Our hypothesis is that inspecting the UPJ during pyeloplasty may not be a sufficient way to delineate the underlying cause of obstruction in every individual. MATERIAL AND METHODS: We retrospectively reviewed the data of 56 patients who had dismembered pyeloplasty. The intrinsic and extrinsic groups consisted of 38 and 18 patients, respectively. Masson's trichrome stain, CD117, and connexin 43 (Cx43) antibody were used in histopathology and immunochemistry. Statistical calculations were done with chi-square and Mann-Whitney U tests. DISCUSSION: Connexin 43 staining pattern, CD117 positive cell count, and the extent of fibrosis did not differ significantly between extrinsic and intrinsic cases. However, the difference with regard to the degree of muscular hypertrophy was close to statistical significance. The exact pathophysiological mechanism underlying UPJO has yet to be elucidated. A study directly comparing both groups histologically is indeed rare. Our study showed that there are no significant differences between the intrinsic and extrinsic groups in terms of the pacemaker activity, gap junctional communication, and extent of fibrosis. Muscular hypertrophy, which was marginally higher in our extrinsic group, may persist despite successful relocation of the obstructing vessel. The main drawbacks of our study are; the absence of a control group and the retrospective study design with its inherent selection biases. CONCLUSIONS: Immunohistochemical profiles of intrinsic and extrinsic UPJOs resemble each other. Intraoperative inspection of the UPJ may not be enough for accurate discrimination for a surgical procedure that can correct only the extrinsic cause.
Tipo de publicação: JOURNAL ARTICLE


  9 / 1429 MEDLINE  
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PMID:26790611
Autor:El Hoshy K; Bosseila M; El Sharkawy D; Sobhi R
Endereço:Dermatology Department, Faculty of Medicine, Cairo University, Egypt.
Título:Can basal cell carcinoma lateral border be determined by fluorescence diagnosis?: Verification by Mohs micrographic surgery.
Fonte:Photodiagnosis Photodyn Ther; 14:4-8, 2016 Jun.
ISSN:1873-1597
País de publicação:Netherlands
Idioma:eng
Resumo:BACKGROUND: The preferential accumulation of 5-aminolaevulinic acid (ALA)-induced protoporphyrin IX (PpIX) in neoplastic cells supports its potential use in the photodetection of epithelial tumours through porphyrin fluorescence. OBJECTIVE: To assess the validity of fluorescence diagnosis (FD) as an efficient pre-surgical in vivo imaging tool for defining the lateral boundaries of various types of basal cell carcinomas (BCCs). METHODS: The BCC tumour area was determined for 27 patients using FD digitalized imaging system, where the accumulation of PpIX in tumour tissue in relation to normal tissue was measured. Subsequently, BCCs were excised according to the complete area defined by FD using Mohs micrographic surgery (MMS). RESULTS: Of the 27 BCCs, the FD margin of the lesion coincided with the histopathological picture in 12 BCCs (44.44%). The mean value of accumulation factor (AF) was 2.7. Although 17 pigmented BCCs showed attenuated or absent fluorescence in the center, fluorescence at their periphery was used as a guide for excision, and statistically, the pigmentation of the BCCs showed no effect on the results of the FD efficacy (p=1.0). CONCLUSION: Fluorescence diagnosis of BCC may be beneficial as a guide to the safety margin needed before MMS. The safety margin is decided according to the FD tumour diameter in relation to the clinical tumour diameter.
Tipo de publicação: JOURNAL ARTICLE; VALIDATION STUDIES
Nome de substância:0 (Protoporphyrins); 88755TAZ87 (Aminolevulinic Acid); C2K325S808 (protoporphyrin IX)


  10 / 1429 MEDLINE  
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PMID:26776747
Autor:Hart J; Pastore G; Jones M; Barker A; Khosa J; Samnakay N
Endereço:University of Western Australia, Perth, Australia; Princess Margaret Hospital for Children, Perth, Australia.
Título:Chronic orchalgia after surgical exploration for acute scrotal pain in children.
Fonte:J Pediatr Urol; 12(3):168.e1-6, 2016 Jun.
ISSN:1873-4898
País de publicação:England
Idioma:eng
Resumo:OBJECTIVES: The aim was to review the pediatric cohort undergoing surgical exploration for acute scrotal pain at our institution and assess the entity of chronic orchalgia post exploration in this cohort. MATERIALS AND METHODS: A retrospective review of all pediatric patients who underwent surgery for acute scrotal pain at a single institution between 1 January 2001 and 1 January 2012 was conducted. RESULTS: A total of 1084 patients underwent scrotal exploration for acute scrotal pain where the underlying cause could not be clinically ascertained. Causes found at exploratory surgery are shown in the table. Forty-four children (4.1%) re-presented with another episode of acute scrotal pain and underwent re-exploration. A hundred of the 772 children with testicular appendage torsion at initial exploration had unilateral exploration only. Seven (7%) of these re-presented with contralateral appendage torsion. The complication rate of initial scrotal exploration was 5.6% and that of re-exploration was 6.8%. All complications were managed conservatively except for a painful reactive hydrocele that underwent the Jaboulay procedure. Fifteen (1.4%) children in this cohort developed chronic orchalgia. Thirteen (87%) of these had definite pathology found at initial exploration. One of 61 (2%) with postoperative complications (a reactive hydrocele) developed chronic orchalgia. Pediatric chronic pain specialists were consulted for all patients. In 10 of the 15 (67%), significant comorbidities included constipation, anxiety, somatization, hydrocele, dysfunctional voiding, and multiple joint pain. The Jaboulay procedure for reactive hydrocele and re-exploration to pex the testes due to suspected intermittent testicular torsion resolved chronic orchalgia in one patient each. DISCUSSION: Pediatric chronic orchalgia post exploration is uncommon. It has a multifactorial etiology. Comorbidities are common. It is possible that some unexplored patients labeled as chronic orchalgia in the literature may have underlying correctable pathology. Surgically correctable pathology such as intermittent testicular torsion, metachronous testicular appendage torsion, and symptomatic hydrocele or varicocele should be excluded in children with chronic orchalgia. Chronic pain specialists should be consulted and associated comorbidities managed. Prior surgical exploration and testicular fixation in children with chronic orchalgia helped reassure patients and families that there was no underlying surgical cause for the pain and facilitated compliance with chronic pain management. CONCLUSIONS: Pediatric chronic orchalgia has a multifactorial etiology and is uncommon after scrotal exploration surgery. Comorbidities are common and must be managed. Surgical exploration helps reassure patients that there is no correctable cause for the pain and facilitates engagement with chronic pain management.
Tipo de publicação: JOURNAL ARTICLE



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