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Journal of Obstetrics and Gynaecology :... Dec 2024Cervical cancer survivors can experience vaginal length shortening, vaginal stenosis, vaginal elasticity deterioration, sexual frequency reduction and sexual...
BACKGROUND
Cervical cancer survivors can experience vaginal length shortening, vaginal stenosis, vaginal elasticity deterioration, sexual frequency reduction and sexual dysfunction. This prospective, uncontrolled, monocentric clinical interventional study aimed to evaluate the effect of vaginal dilation therapy on vaginal condition and sexual function of cervical cancer survivors who had not received timely vaginal dilation.
METHODS
A total of 139 patients completed the study. They received 6 months of vaginal dilation therapy. We evaluated their vaginal elasticity, vaginal diameter, vaginal length and sexual function before and after vaginal dilation therapy. Their vaginal conditions were evaluated by customised vaginal moulds, and the sexual function was assessed by female sexual function index. The SPSS 25 software was used to analyse all the data.
RESULTS
Age, vaginal diameter and sexual intercourse frequency before diagnosis were significantly associated with female sexual dysfunction of the patients after cancer treatment. Vaginal dilation therapy improved vaginal stenosis, vaginal length and sexual function in all the patients; however, the vaginal elasticity and incidence of sexual dysfunction did not improve significantly. Sexual intercourse frequency before diagnosis, vaginal elasticity, time interval from last treatment and treatment modalities were significantly associated with the change in female sexual function index score before and after vaginal dilation therapy. Patients with a time interval from the last treatment less than 24 months or those who had moderate or good vaginal elasticity, benefitted more from vaginal dilatation therapy.
CONCLUSIONS
Cervical cancer survivors who had not received timely vaginal dilation still benefitted from vaginal dilation therapy, irrespective of the treatment methods they received. Moreover, vaginal dilation therapy should be performed as early as possible after cervical cancer treatment.
Topics: Humans; Female; Uterine Cervical Neoplasms; Cancer Survivors; Vagina; Constriction, Pathologic; Dilatation; Prospective Studies; Elasticity
PubMed: 38466132
DOI: 10.1080/01443615.2024.2317387 -
Gastrointestinal Endoscopy Jul 2024Limited data exist evaluating lumen-apposing metal stents (LAMSs) with endoscopic balloon dilation (EBD) for the treatment of benign colorectal anastomotic strictures... (Comparative Study)
Comparative Study
BACKGROUND AND AIMS
Limited data exist evaluating lumen-apposing metal stents (LAMSs) with endoscopic balloon dilation (EBD) for the treatment of benign colorectal anastomotic strictures (BCASs). This study compares outcomes of both interventions.
METHODS
Patients with left-sided BCAS treated with LAMSs versus EBD were identified retrospectively. The primary outcome was a composite of crossover to another intervention to achieve clinical success or recurrence requiring reintervention.
RESULTS
Twenty-nine patients (11 LAMS and 18 EBD) were identified with longer follow-up in the EBD group (734 vs 142 days; P = .003). No significant differences were found in the composite outcome, technical success, clinical success, or components of composite outcome. With LAMS, there was a nonsignificant trend toward fewer procedures (2.4 vs 3.3; P = .06) and adverse events (0% vs 16.7%; P = .26).
CONCLUSIONS
LAMS appears to be as effective as EBD for the treatment of BCAS but may require fewer procedures and may be safer than EBD.
Topics: Humans; Female; Male; Middle Aged; Retrospective Studies; Constriction, Pathologic; Anastomosis, Surgical; Dilatation; Aged; Stents; Colonoscopy; Rectum; Colon; Treatment Outcome; Postoperative Complications; Adult; Recurrence
PubMed: 38462058
DOI: 10.1016/j.gie.2024.03.008 -
Langenbeck's Archives of Surgery Mar 2024Endoluminal vacuum sponge therapy has dramatically improved the treatment of anastomotic leaks in esophageal surgery. However, the blind insertion of vacuum sponge kits...
PURPOSE
Endoluminal vacuum sponge therapy has dramatically improved the treatment of anastomotic leaks in esophageal surgery. However, the blind insertion of vacuum sponge kits like Eso-Sponge® via an overtube and a pusher can be technically difficult.
METHODS
We therefore insert our sponges under direct visual control by a nonstandard "piggyback" technique that was initially developed for the self-made sponge systems preceding these commercially available kits.
RESULTS
Using this technique, we inserted or changed 56 Eso-Sponges® in seven patients between 2018 and 2023. Apart from one secondary sponge dislocation, no intraprocedural complications were encountered. One patient died due to unrelated reasons. In all others, the defects healed and they were dismissed from the hospital. Long-term follow-up showed three strictures that were successfully treated by dilatation.
CONCLUSION
We conclude that sponge placement via piggyback technique is a fast, safe, and successful alternative to the standard method of insertion.
Topics: Humans; Anastomotic Leak; Vacuum; Constriction, Pathologic
PubMed: 38441680
DOI: 10.1007/s00423-024-03272-5 -
Neurosurgical Focus Mar 2024Ethmoidal dural arteriovenous fistulas (DAVFs) are often associated with cortical venous drainage (CVD) and a higher incidence of hemorrhage compared with DAVFs in other... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Ethmoidal dural arteriovenous fistulas (DAVFs) are often associated with cortical venous drainage (CVD) and a higher incidence of hemorrhage compared with DAVFs in other locations. They may be treated with open surgical disconnection or with endovascular treatment (EVT). In this systematic review and meta-analysis, the authors compare the outcomes of ethmoidal DAVFs treated with open microsurgery versus EVT and report four additional cases of ethmoidal DAVFs treated with open microsurgery in their institution.
METHODS
A literature search of the PubMed and Scopus databases was conducted between December 2021 and May 2022 to identify relevant articles published between 1990 and 2021 using the PRISMA guidelines. References were reviewed and screened by two authors independently, and disagreements were resolved through consensus. Exclusion criteria included non-English-language studies, those with an incorrect study design, those reporting DAVFs in a nonethmoidal location, and studies whose outcomes were not stratified based on DAVF location. Inclusion criteria were any studies reporting on ethmoidal DAVFs treated by either microsurgery or EVT. A risk of bias assessment was performed using the Newcastle-Ottawa Scale. The authors performed a pooled proportional meta-analysis to compare patient outcomes.
RESULTS
Twenty studies were included for analysis. Of 224 patients, 142 were treated with surgery, while 103 were treated with EVT. Seventy percent (148/210) of the patients were symptomatic at presentation, with hemorrhage being the most common presentation (48%). CVD was present in 98% of patients and venous ectasia in 61%. The rates of complete DAVF obliteration with surgery and EVT were 89% and 70%, respectively (95% CI -30% to -10%, p < 0.03). Twenty percent (21/103) of endovascularly treated fistulas required subsequent surgery. Procedure-related complications occurred in 10% of the surgical cases, compared with 13% of the EVT cases. The authors' case series included 4 patients with ethmoidal DAVFs treated surgically with complete obliteration, without any postoperative complications.
CONCLUSIONS
The complete obliteration rates of ethmoidal DAVF appear to be higher and more definitive with microsurgical intervention than with EVT. While complication rates between the two procedures seem similar, patients treated with EVT may require further interventions for definitive treatment. The limitations of this study include its retrospective nature, the quality of studies included, and the continued evolving technologies of EVT. Future studies should focus on the association between venous drainage pattern and the proclivity toward venous ectasia or rate of hemorrhage at presentation.
Topics: Humans; Central Nervous System Vascular Malformations; Dilatation, Pathologic; Embolization, Therapeutic; Hemorrhage; Treatment Outcome; Microsurgery
PubMed: 38428011
DOI: 10.3171/2023.12.FOCUS23801 -
World Journal of Gastrointestinal... Feb 2024Light chain (AL) amyloidosis is a plasma cell dyscrasia characterized by the pathologic production and extracellular tissue deposition of fibrillar proteins derived from...
BACKGROUND
Light chain (AL) amyloidosis is a plasma cell dyscrasia characterized by the pathologic production and extracellular tissue deposition of fibrillar proteins derived from immunoglobulin AL fragments secreted by a clone of plasma cells, which leads to progressive dysfunction of the affected organs. The two most commonly affected organs are the heart and kidneys, and liver is rarely the dominant affected organ with only 3.9% of cases, making them prone to misdiagnosis and missed diagnosis.
CASE SUMMARY
A 65-year-old woman was admitted with a 3-mo history of progressive jaundice and marked hepatomegaly. Initially, based on enhanced computed tomography scan and angiography, Budd-Chiari syndrome was considered and balloon dilatation of significant hepatic vein stenoses was performed. However, additional diagnostic procedures, including liver biopsy and bone marrow-examination, revealed immunoglobulin kapa AL amyloidosis with extensive liver involvement and hepatic vascular compression. The disease course was progressive and fatal, and the patient eventually died 5 mo after initial presentation of symptoms.
CONCLUSION
AL amyloidosis with isolated liver involvement is very rare, and can be easily misdiagnosed as a vascular disease.
PubMed: 38425387
DOI: 10.4251/wjgo.v16.i2.550 -
World Journal of Gastrointestinal... Feb 2024Colorectal cancer is the third most prevalent malignancy globally and ranks second in cancer-related mortality, with the liver being the primary organ of metastasis....
BACKGROUND
Colorectal cancer is the third most prevalent malignancy globally and ranks second in cancer-related mortality, with the liver being the primary organ of metastasis. Preoperative chemotherapy is widely recommended for initially or potentially resectable colorectal liver metastases (CRLMs). Tumour pathological response serves as the most important and intuitive indicator for assessing the efficacy of chemotherapy. However, the postoperative pathological results reveal that a considerable number of patients exhibit a poor response to preoperative chemotherapy. Body mass index (BMI) is one of the factors affecting the tumorigenesis and progression of colorectal cancer as well as prognosis after various antitumour therapies. Several studies have indicated that overweight and obese patients with metastatic colorectal cancer experience worse prognoses than those with normal weight, particularly when receiving first-line chemotherapy regimens in combination with bevacizumab.
AIM
To explore the predictive value of BMI regarding the pathologic response following preoperative chemotherapy for CRLMs.
METHODS
A retrospective analysis was performed in 126 consecutive patients with CRLM who underwent hepatectomy following preoperative chemotherapy at four different hospitals from October 2019 to July 2023. Univariate and multivariate logistic regression models were applied to analyse potential predictors of tumour pathological response. The Kaplan-Meier method with log rank test was used to compare progression-free survival (PFS) between patients with high and low BMI. BMI < 24.0 kg/m was defined as low BMI, and tumour regression grade 1-2 was defined as complete tumour response.
RESULTS
Low BMI was observed in 74 (58.7%) patients and complete tumour response was found in 27 (21.4%) patients. The rate of complete tumour response was significantly higher in patients with low BMI (29.7% 9.6%, = 0.007). Multivariate analysis revealed that low BMI [odds ratio (OR) = 4.56, 95% confidence interval (CI): 1.42-14.63, = 0.011], targeted therapy with bevacizumab (OR = 3.02, 95%CI: 1.10-8.33, = 0.033), preoperative carcinoembryonic antigen level < 10 ng/mL (OR = 3.84, 95%CI: 1.19-12.44, = 0.025) and severe sinusoidal dilatation (OR = 0.17, 95%CI: 0.03-0.90, = 0.037) were independent predictive factors for complete tumour response. The low BMI group exhibited a significantly longer median PFS than the high BMI group (10.7 mo 4.7 mo, = 0.011).
CONCLUSION
In CRLM patients receiving preoperative chemotherapy, a low BMI may be associated with better tumour response and longer PFS.
PubMed: 38425385
DOI: 10.4251/wjgo.v16.i2.331 -
Differences in anterior chamber depth in keratoconus patients with binocular very asymmetry ectasia.BMC Ophthalmology Feb 2024To evaluate the difference in anterior chamber depth (ACD) between two eyes among keratoconus patients with binocular very asymmetric ectasia (VAE) and to explore the...
BACKGROUND
To evaluate the difference in anterior chamber depth (ACD) between two eyes among keratoconus patients with binocular very asymmetric ectasia (VAE) and to explore the influencing factors.
METHODS
The corneal curvature and ACD in both eyes of patients with VAE were measured by Sirius (version 3.2, CSO, Italy) at the following points: corneal vertex, maximum curvature (apex), and the 1.5 mm, 2.5 mm, and 3.5 mm superior-, inferior-, nasal-, temporal-paracentral from center. The mean pupil power (MPP) and corneal morphology parameters were also measured. Correlations between ACD and curvature and morphology parameters were analyzed by linear regression.
RESULTS
172 eyes of 86 patients (9 to 45 years) were classified into the VAE-N (n = 86) group and the VAE-E group (n = 86) based on the corneal morphology. The central (3.32 ± 0.27 mm versus 3.43 ± 0.29 mm, P < 0.001) and paracentral ACDs increased significantly in the VAE-E group, and the corneal morphology parameters were also significantly higher. The central ACD was significantly correlated with the MPP (r = 0.465), KVf/b (Keratoconus Vertex front/back) (r = 0.306, r = 0.327), and BCVf/b (Baiocchi Calossi Versaci front/back) (r = 0.356, r = 0.416). Linear regression showed good relationships between △ACD and △MPP (R = 0.429) and △KVf/b (R = 0.504, R = 0.536).
CONCLUSIONS
The ACD was larger in the VAE-E group. The difference in ACD between the VAE-E and VAE-N groups was significantly correlated with corneal curvature and the extent of corneal elevation, indicating the influences of both the corneal magnification effect and corneal ectasia on ACD.
Topics: Humans; Keratoconus; Corneal Topography; Corneal Pachymetry; Dilatation, Pathologic; Cornea; Anterior Chamber
PubMed: 38408954
DOI: 10.1186/s12886-024-03353-5 -
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi =... Feb 2024The mechanical properties of the cornea in corneal ectasia disease undergo a significant reduction, yet the alterations in mechanical properties within distinct corneal...
The mechanical properties of the cornea in corneal ectasia disease undergo a significant reduction, yet the alterations in mechanical properties within distinct corneal regions remain unclear. In this study, we established a rabbit corneal ectasia model by employing collagenase II to degrade the corneal matrix within a central diameter of 6 mm. Optical coherence tomography was employed for the assessment of corneal morphology (corneal thickness and corneal curvature) one month after operation. Anisotropy and viscoelastic characteristics of corneal tissue were evaluated through biaxial and uniaxial testing, respectively. The results demonstrated a marked decrease in central corneal thickness, with no significant changes observed in corneal curvature. Under different strains, the elastic modulus of the cornea exhibited no significant differences in the up-down and naso-temporal directions between the control and model groups. However, the cornea in the model group displayed a significantly lower elastic modulus compared to the control group. Specifically, the elastic modulus of the central region cornea in the model group was significantly lower than that of the entire cornea within the same group. Moreover, in comparison to the control group, the cornea in the model group exhibited a significant increase in both creep rate and overall deformation rate. The instantaneous modulus and equilibrium modulus were significantly reduced in the model cornea. No significant differences were observed between the entire cornea and the central cornea concerning these parameters. The results indicate that corneal anisotropy remains unchanged in collagenase-induced ectatic cornea. However, a significant reduction in viscoelastic properties is noticed. This study provides valuable insights for investigating changes in corneal mechanical properties within different regions of ectatic corneal disease.
Topics: Animals; Rabbits; Dilatation, Pathologic; Anisotropy; Cornea; Corneal Diseases; Collagenases
PubMed: 38403613
DOI: 10.7507/1001-5515.202312022 -
Viruses Feb 2024Metabolic-dysfunction-associated fatty liver disease (MAFLD) is a major cause of morbidity and mortality in HIV-infected individuals, even those receiving optimal...
Metabolic-dysfunction-associated fatty liver disease (MAFLD) is a major cause of morbidity and mortality in HIV-infected individuals, even those receiving optimal antiretroviral therapy. Here, we utilized the SIV rhesus macaque model and advanced laparoscopic techniques for longitudinal collection of liver tissue to elucidate the timing of pathologic changes. The livers of both SIV-infected (N = 9) and SIV-naïve uninfected (N = 8) macaques were biopsied and evaluated at four time points (weeks -4, 2, 6, and 16-20 post-infection) and at necropsy (week 32). SIV DNA within the macaques' livers varied by over 4 logs at necropsy, and liver SIV DNA significantly correlated with SIV RNA in the plasma throughout the study. Acute phase liver pathology (2 weeks post-infection) was characterized by evidence for fat accumulation (microvesicular steatosis), a transient elevation in both AST and cholesterol levels within the serum, and increased hepatic expression of the PPARA gene associated with cholesterol metabolism and beta oxidation. By contrast, the chronic phase of the SIV infection (32 weeks post-infection) was associated with sinusoidal dilatation, while steatosis resolved and concentrations of AST and cholesterol remained similar to those in uninfected macaques. These findings suggest differential liver pathologies associated with the acute and chronic phases of infection and the possibility that therapeutic interventions targeting metabolic function may benefit liver health in people newly diagnosed with HIV.
Topics: Animals; Humans; Simian Acquired Immunodeficiency Syndrome; Simian Immunodeficiency Virus; Macaca mulatta; HIV Infections; Fatty Liver; Hepatocytes; DNA; Cholesterol
PubMed: 38400071
DOI: 10.3390/v16020296 -
Catheterization and Cardiovascular... Apr 2024Iliofemoral deep vein thrombosis (IFDVT) causes severe symptoms and affect the quality of life to a great extent. Endovascular thrombectomy and stent implantation have... (Observational Study)
Observational Study
BACKGROUND
Iliofemoral deep vein thrombosis (IFDVT) causes severe symptoms and affect the quality of life to a great extent. Endovascular thrombectomy and stent implantation have been a feasible strategie to alleviate the signs and symptoms of IFDVT. However, venous in-stent restenosis (ISR) has become an emerging non-negligible problem.
METHODS
To evaluate the histological characteristics of venous ISR, neointima of arterial and venous ISR patients were collected and examed. To explore the effect of drug-coated balloon (DCB) on venous ISR lesions, we conducted a single-center retrospective case series study involving IFDVT patients with ISR after venous stenting who were treated with paclitaxel-coated balloon dilatation.
RESULTS
We found a collagen-rich matrix but not elastin, as well as fewer cells and less neovascularization in venous intimal hyperplasia compared with neointima in arteries. Thirteen IFDVT patients were involved in the study, with average preoperative stenosis degree of 87.69% ± 13.48%. After intervention, the stenosis degree was significantly reduced to 14.6% ± 14.36% immediately (p < 0.0001) and to 16.54% ± 15.73% during follow-up (p < 0.0001). During follow-up, the VEINES-QOL scores (p < 0.0001), VEINES-Sym scores (p < 0.0001), and Villalta scores (p = 0.04) of patients was improved significantly compared with those before intervention. No major adverse events were observed.
CONCLUSIONS
The use of DCB may have a positive effect in the treatment of venous ISR by targeting intimal hyperplasia. Moreover, the application of DCB dilatation in IFDVT stenting patients with ISR is deemed safe and effective.
Topics: Humans; Angioplasty, Balloon, Coronary; Quality of Life; Constriction, Pathologic; Coronary Restenosis; Retrospective Studies; Neointima; Hyperplasia; Treatment Outcome; Stents; Paclitaxel; Venous Thrombosis; Coated Materials, Biocompatible
PubMed: 38385905
DOI: 10.1002/ccd.30975