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Obstetrical & Gynecological Survey Jun 2009To review systematically the literature, published in English, on recurrence and healing after treatment of Bartholin duct cysts and abscesses. (Review)
Review
OBJECTIVE
To review systematically the literature, published in English, on recurrence and healing after treatment of Bartholin duct cysts and abscesses.
DATA SOURCES
We searched PubMed, EMBASE, CINAHL, LILACS, Web-of-science, the Cochrane database, and POPLINE from 1982 until May 2008. We searched the internet, hand-searched reference lists, and contacted experts and authors of relevant papers to detect all published and unpublished studies.
METHODS OF STUDY SELECTION
We included any study with at least 10 participants, addressing either frequency of recurrence or healing time after treatment of Bartholin duct cyst or abscess. We followed MOOSE (meta-analysis of observational studies in epidemiology) guidelines. Of 532 articles identified, 24 studies (5 controlled trials, 2 cohort studies, and 17 case series) met all inclusion criteria. Study size ranged between 14 and 200 patients.
TABULATION, INTEGRATION, AND RESULTS
The interventions included: (1) Silver nitrate gland ablation, (2) cyst or abscess fenestration, ablation, or excision using carbon dioxide (CO(2)) laser, (3) marsupialization, (4) needle aspiration with or without alcohol sclerotherapy, (5) fistulization using a Word catheter, Foley catheter, or Jacobi ring, (6) gland excision, and (7) incision and drainage followed by primary suture closure. The reported frequency of recurrence varied from 0% to 38%. There was no recurrence after marsupialization in available studies. Recurrence after other treatments varied, and was most common after aspiration alone. Healing generally occurred in 2 weeks or less.
CONCLUSION
There are multiple treatments for Bartholin duct cysts and abscesses. A review of the literature failed to identify a best treatment approach.
TARGET AUDIENCE
Obstetricians & Gynecologists, Family Physicians
LEARNING OBJECTIVES
After completion of this article, the reader should be able to identify seven different treatments for Bartholin duct cysts or abscesses, contrast treatment choice complications and recurrence risks for the different options for treatment of Bartholin duct cysts or abscesses, and point out the limited quality and quantity of data upon which to choose best practices.
Topics: Ablation Techniques; Abscess; Bartholin's Glands; Cysts; Drainage; Female; Gynecologic Surgical Procedures; Humans; Minimally Invasive Surgical Procedures; Sclerotherapy; Secondary Prevention
PubMed: 19445813
DOI: 10.1097/OGX.0b013e31819f9c76 -
The Cochrane Database of Systematic... Jul 2006In advanced stage primary vulvar cancer, treatment is tailored to individual patient needs. Combined treatment modalities have been developed, using chemotherapy,... (Review)
Review
BACKGROUND
In advanced stage primary vulvar cancer, treatment is tailored to individual patient needs. Combined treatment modalities have been developed, using chemotherapy, radiotherapy and surgery.
OBJECTIVES
To determine whether the combined treatment strategy using concurrent neoadjuvant chemoradiation therapy followed by surgery is effective and safe in vulvar cancer patients with advanced primary disease. Main outcomes of interest were: types of surgical intervention following chemoradiation and survival, recurrence and complication rates.
SEARCH STRATEGY
We searched the Cochrane Gynaecological Cancer Review Group Specialised Register. The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE (PubMed), EMBASE, CANCERLIT, other databases and reference lists of articles. The latest search was conducted on 12 March 2005.
SELECTION CRITERIA
Studies of curative treatment of patients with advanced, primary squamous cell carcinoma of the vulva were included. Treatment included concurrent radiotherapy and chemotherapy, followed by surgery.
DATA COLLECTION AND ANALYSIS
Twenty-eight abstracts and papers were selected either by the search strategy or by checking the cross references. Randomised controlled trials (RCTs) were not available. Five studies met the inclusion criteria. (Eifel 1995; Landoni 1996; Montana 2000; Moore 1998; Scheistroen 1993). Two authors (HCvD, MV-L) independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects information was collected from the trials.
MAIN RESULTS
Chemotherapy was given uniformly within each of the five selected studies. However, four different chemoradiation schedules were applied. Radiotherapy dose fractionation techniques, fields and target definitions varied. Skin toxicity was observed in nearly all patients. Wound breakdown, infection, lymphedema, lymphorrhea and lymphoceles were also common. Operability was achieved in 63 to 92% of cases in the four studies using 5FU and CDDP or 5FU and MMC. In contrast, only 20% of the patients who received Bleomycin were operable after chemoradiation. After a follow up of 5 to 125 months, 26 to 63% of participants were alive and well. A total of 27 to 85% of participants died due to treatment related causes or disease. The five studies included in this review show that preoperative chemoradiotherapy reduces tumour size and improves operability. However, complications of treatment are considerable and information on the effects of quality of life (QOL) is not available. Furthermore, treatment results of the respective studies diverge considerably.
AUTHORS' CONCLUSIONS
Patients with inoperable primary tumours or lymph nodes benefit from chemoradiation if an operation can be performed. In patients with large tumours that can only be treated with anterior and/or posterior exenteration complications of neoadjuvant therapy might outweigh complications of exenterative surgery. With the current knowledge neoadjuvant therapy is not justified in patients with tumours that can be adequately treated with radical vulvectomy and bilateral groin node dissection alone.
Topics: Carcinoma, Squamous Cell; Female; Humans; Neoadjuvant Therapy; Vulvar Neoplasms
PubMed: 16856018
DOI: 10.1002/14651858.CD003752.pub2 -
International Journal of STD & AIDS May 2003The incidence of reporting of penile intraepithelial neoplasia (PIN) by genitourinary medicine clinics in the UK is rare. The reporting of higher incidence, in most... (Review)
Review
The incidence of reporting of penile intraepithelial neoplasia (PIN) by genitourinary medicine clinics in the UK is rare. The reporting of higher incidence, in most international studies, is suggestive of under-diagnosis of PIN lesions in the UK, which leads to improper therapy and follow-up. A systematic literature review is undertaken, regarding the current state of management of PIN and the possible avenues of improvement in the diagnosis and follow-up. The role of genitourinary medicine clinics is examined, in view of the high number of patients that present with genital dermatological conditions, in whom there are patients with non-identified PIN lesions. The notable increase in reporting of vulval intraepithelial neoplasia has been associated with an increase in vulval cancer, especially in younger patients. The possibility of a similar trend in penile lesions needs to be observed and the association between high risk human papillomavirus (HPV) types, and genital intraepithelial neoplasia and cancer, is recognized and therefore an increased incidence in the diagnosis of HPV associated lesions must be considered.
Topics: Carcinoma in Situ; Diagnosis, Differential; Humans; Male; Papillomaviridae; Papillomavirus Infections; Penile Neoplasms; Prognosis; Skin Diseases
PubMed: 12803938
DOI: 10.1258/095646203321605512 -
The Cochrane Database of Systematic... 2001Pubic or perineal shaving is a procedure performed before birth in order to lessen the risk of infection if there is a spontaneous perineal tear or if an episiotomy is... (Review)
Review
BACKGROUND
Pubic or perineal shaving is a procedure performed before birth in order to lessen the risk of infection if there is a spontaneous perineal tear or if an episiotomy is performed.
OBJECTIVES
To assess the effects of routine perineal shaving on admission in labour on maternal and neonatal outcomes, according to the best available evidence.
SEARCH STRATEGY
The register of clinical trials maintained and updated by the Cochrane Pregnancy and Childbirth Group. In addition, the Cochrane Controlled Trials Register was searched. Date of last search: July 2000.
SELECTION CRITERIA
All controlled trials (including quasi randomised) which compared perineal shaving versus no perineal shaving were included in the review.
DATA COLLECTION AND ANALYSIS
Trials under consideration were evaluated for methodological quality and appropriateness for inclusion, without consideration of their results.
MAIN RESULTS
Only two trials fulfilled the prespecified criteria. In the earlier trial, 389 women were alternately allocated to receive either skin preparation and perineal shaving (control) or clipping of vulval hair only (experimental). In the second trial, which included 150 participants, perineal shaving was compared with the cutting of long hairs for procedures only. The primary outcome for both trials was maternal febrile morbidity. No differences were found (combined odds ratio (OR) 1.26, 95% confidence interval (CI) 0.75, 2.12). In the smaller trial, fewer women who had not been shaved had gram negative bacterial colonisation compared with women who had been shaved (OR 0.43, 95% CI 0.20, 0.92).
REVIEWER'S CONCLUSIONS
There is insufficient evidence to recommend perineal shaving for women on admission in labour.
Topics: Confidence Intervals; Controlled Clinical Trials as Topic; Female; Hair Removal; Humans; Labor, Obstetric; Odds Ratio; Patient Admission; Perineum; Pregnancy
PubMed: 11279711
DOI: 10.1002/14651858.CD001236