Gynecologic oncology
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Gynecologic oncology · Sep 2008
Impact of vaccination with Cervarix (trade mark) on subsequent HPV-16/18 infection and cervical disease in women 15-25 years of age.
Cervical cancer of both squamous and adenocarcinoma types is considered virtually 100% attributable to human papillomavirus (HPV) infection. HPV-16 and -18 are the predominant types worldwide accounting for over 70% of all cervical cancer. Persistent oncogenic HPV infection has been confirmed as one key determinant in the development of cervical precancer (cervical intraepithelial neoplasia [CIN] 2+) and cervical cancer. ⋯ These individual studies include populations with different underlying risk factors, each of which shows high efficacy against both HPV-16/18 persistent infections and CIN2+. When the two studies are combined and the respective populations are evaluated, vaccine efficacy against HPV-16 and -18-related CIN2+ remains at 100%. As this vaccine is used over time in universal prophylactic HPV-16/18 vaccination of girls and women, reductions in cervical cancers at both the individual and public health levels will be appreciated.
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Gynecologic oncology · Aug 2008
Case ReportsNovel perioperative imaging with 18F-FDG PET/CT and intraoperative 18F-FDG detection using a handheld gamma probe in recurrent ovarian cancer.
Diagnostic (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) is an established method for detecting ovarian cancer. However, there is no established method to detect hypermetabolic tumor intraoperatively to evaluate disease extent and assure complete resection. We describe an innovative approach for intraoperative tumor localization and verification of tumor resection utilizing (18)F-FDG for perioperative PET/CT imaging and intraoperative gamma probe detection in ovarian cancer. ⋯ Perioperative PET/CT imaging with intraoperative detection using a gamma probe following a single (18)F-FDG injection dose is feasible, establishes the location and extent of disease, and confirms a complete cytoreduction for recurrent ovarian cancer.
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Gynecologic oncology · May 2008
The incidence and risk factors associated with postoperative delirium in geriatric patients undergoing surgery for suspected gynecologic malignancies.
The incidence of postoperative delirium (PD) in the elderly ranges between 3-60% but has never been examined in gynecologic oncology. Our goal was to identify pre, intra, and postoperative risk factors associated with the development of PD. ⋯ PD is a common complication in older women undergoing major gynecologic surgery. Increased narcotics, age, and preoperative medications were strongly associated with this adverse event. Prevention needs to focus on i) identifying patients at higher risk for PD based on preoperative parameters, and ii) eliminating known postoperative risk factors.
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Gynecologic oncology · May 2008
ReviewThe current and future role of screening in the era of HPV vaccination.
With the introduction of cervical screening programs, the incidence and mortality of cervical cancer has been drastically reduced. Techniques such as the traditional Papanicolaou test and the newer liquid-based cytology allow for the early detection of cervical abnormalities prior to the development of invasive cervical cancer. As oncogenic human papillomavirus (HPV) infection is necessary for cervical cancer, HPV-DNA testing has also been proposed as a routine screening method for the general population. ⋯ These vaccines protect against the initial infection of certain oncogenic HPV types, and therefore prevent the development of cervical dysplasia, precancerous lesions, and cervical cancer. Considering routine cervical cancer vaccination in adolescent girls, screening guidelines must adapt in order to retain efficient and cost-effective prevention measures. Although the true epidemiological and economic impact of cervical cancer vaccines cannot be immediately realized, mathematical models predict various scenarios in which vaccination, in addition to cervical screening, will be cost-effective and further reduce cervical cancer disease.
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Gynecologic oncology · Apr 2008
Low risk of complications associated with the fenestrated peritoneal catheter used for intraperitoneal chemotherapy in ovarian cancer.
We previously reported a 10% rate of catheter complications, including inflow obstruction and infection, using a fenestrated catheter to administer intraperitoneal (i.p.) chemotherapy for ovarian cancer. Because of recent reports of higher rates of catheter complications, we performed this study to update our experience with the fenestrated catheter. ⋯ The fenestrated catheter for i.p. chemotherapy continues to be associated with a low risk of catheter-related complications. The low rate of complications, even in the setting of bowel resection and increase in utilization during upfront chemotherapy, suggest that the fenestrated catheter is still a feasible method for the administration of i.p. chemotherapy.