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International Journal of Dermatology Jun 2020Actinic keratosis (AK) is a very common skin disease caused by chronic sun damage, which in 75% of cases arises on chronically sun-exposed areas, such as face, scalp,... (Review)
Review
Actinic keratosis (AK) is a very common skin disease caused by chronic sun damage, which in 75% of cases arises on chronically sun-exposed areas, such as face, scalp, neck, hands, and forearms. AKs must be considered an early squamous cell carcinoma (SCC) for their probable progression into invasive SCC. For this reason, all AK should be treated, and clinical follow-up is recommended. The aims of treatment are: (i) to clinically eradicate evident and subclinical lesions, (ii) to prevent their evolution into SCC, and (iii) to reduce the number of relapses. Among available treatments, it is possible to distinguish lesion-directed therapies and field-directed therapies. Lesion-directed treatments include: (i) cryotherapy; (ii) laser therapy; (iii) surgery; and (iv) curettage. Whereas, field-directed treatments are: (i) 5-fluorouracil (5-FU); (ii) diclofenac 3% gel; (iii) chemical peeling; (iv) imiquimod; and (v) photodynamic therapy (PDT). Prevention plays an important role in the treatment of AKs, and it is based on the continuous use of sunscreen and protective clothing. This review shows different types of available treatments and describes the characteristics and benefits of each medication, underlining the best choice.
Topics: Aftercare; Carcinoma, Squamous Cell; Chemexfoliation; Cryotherapy; Curettage; Dermoscopy; Diclofenac; Disease Progression; Fluorouracil; Humans; Imiquimod; Keratosis, Actinic; Laser Therapy; Photochemotherapy; Practice Guidelines as Topic; Protective Clothing; Skin; Skin Neoplasms; Sunlight; Sunscreening Agents
PubMed: 32012240
DOI: 10.1111/ijd.14767 -
BMJ Clinical Evidence Sep 2015Menorrhagia (also known as heavy menstrual bleeding) limits normal activities, affects quality of life, and causes anaemia in two-thirds of women with objective... (Review)
Review
INTRODUCTION
Menorrhagia (also known as heavy menstrual bleeding) limits normal activities, affects quality of life, and causes anaemia in two-thirds of women with objective menorrhagia (loss of 80 mL blood per cycle). Prostaglandin disorders may be associated with idiopathic menorrhagia and with heavy bleeding due to fibroids, adenomyosis, or use of intrauterine devices (IUDs). Fibroids have been found in 10% of women with menorrhagia overall and in 40% of women with severe menorrhagia; but half of women having a hysterectomy for menorrhagia are found to have a normal uterus.
METHODS AND OUTCOMES
We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of surgical treatments for menorrhagia? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review).
RESULTS
At this update, searching of electronic databases retrieved 205 studies. After deduplication and removal of conference abstracts, 102 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 56 studies and the further review of 46 full publications. Of the 46 full articles evaluated, three systematic reviews and five RCTs were added at this update. We performed a GRADE evaluation for 30 PICO combinations.
CONCLUSIONS
In this systematic overview, we categorised the efficacy for three surgical interventions based on information about the effectiveness and safety of dilatation and curettage, endometrial destruction (resection or ablation), and hysterectomy.
Topics: Dilatation and Curettage; Endometrial Ablation Techniques; Endometrium; Female; Humans; Menorrhagia; Treatment Outcome
PubMed: 26382038
DOI: No ID Found -
JAMA Apr 2023Vacuum aspiration is commonly used to remove retained products of conception in patients with incomplete spontaneous abortion. Scarring of the uterine cavity may occur,...
IMPORTANCE
Vacuum aspiration is commonly used to remove retained products of conception in patients with incomplete spontaneous abortion. Scarring of the uterine cavity may occur, potentially impairing future fertility. A procedural alternative, operative hysteroscopy, has gained popularity with a presumption of better future fertility.
OBJECTIVE
To assess the superiority of hysteroscopy to vacuum aspiration for subsequent pregnancy in patients with incomplete spontaneous abortion who intend to have future pregnancy.
DESIGN, SETTING, AND PARTICIPANTS
The HY-PER randomized, controlled, single-blind trial included 574 patients between November 6, 2014, and May 3, 2017, with a 2-year duration of follow-up. This multicenter trial recruited patients in 15 French hospitals. Individuals aged 18 to 44 years and planned for surgery for an incomplete spontaneous abortion with plans to subsequently conceive were randomized in a 1:1 ratio.
INTERVENTIONS
Surgical treatment by hysteroscopy (n = 288) or vacuum aspiration (n = 286).
MAIN OUTCOMES AND MEASURES
The primary outcome was a pregnancy of at least 22 weeks' duration during 2-year follow-up.
RESULTS
The intention-to-treat analyses included 563 women (mean [SD] age, 32.6 [5.4] years). All aspiration procedures were completed. The hysteroscopic procedure could not be completed for 19 patients (7%), 18 of which were converted to vacuum aspiration (8 with inability to completely resect, 7 with insufficient visualization, 2 with anesthetic complications that required a shortened procedure, 1 with equipment failure). One hysteroscopy failed due to a false passage during cervical dilatation. During the 2-year follow-up, 177 patients (62.8%) in the hysteroscopy group and 190 (67.6%) in the vacuum aspiration (control) group achieved the primary outcome (difference, -4.8% [95% CI, -13% to 3.0%]; P = .23). The time-to-event analyses showed no statistically significant difference between groups for the primary outcome (hazard ratio, 0.87 [95% CI, 0.71 to 1.07]). Duration of surgery and hospitalization were significantly longer for hysteroscopy. Rates of new miscarriages, ectopic pregnancies, Clavien-Dindo surgical complications of grade 3 or above (requiring surgical, endoscopic, or radiological intervention or life-threatening event or death), and reinterventions to remove remaining products of conception did not differ between groups.
CONCLUSIONS AND RELEVANCE
Surgical management by hysteroscopy of incomplete spontaneous abortions in patients intending to conceive again was not associated with more subsequent births or a better safety profile than vacuum aspiration. Moreover, operative hysteroscopy was not feasible in all cases.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02201732.
Topics: Pregnancy; Humans; Female; Adult; Abortion, Spontaneous; Vacuum Curettage; Single-Blind Method; Pregnancy, Ectopic; Hysteroscopy
PubMed: 37039805
DOI: 10.1001/jama.2023.3415 -
BMJ Clinical Evidence Jan 2012Menorrhagia limits normal activities, and causes anaemia in two-thirds of women with objective menorrhagia (loss of 80 mL blood per cycle). Prostaglandin disorders may... (Review)
Review
INTRODUCTION
Menorrhagia limits normal activities, and causes anaemia in two-thirds of women with objective menorrhagia (loss of 80 mL blood per cycle). Prostaglandin disorders may be associated with idiopathic menorrhagia, and with heavy bleeding due to fibroids, adenomyosis, or use of intrauterine devices (IUDs). Fibroids have been found in 10% of women with menorrhagia overall, and in 40% of women with severe menorrhagia; but half of women having a hysterectomy for menorrhagia are found to have a normal uterus.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of medical treatments for menorrhagia? What are the effects of surgical treatments for menorrhagia? What are the effects of endometrial thinning before endometrial destruction in treating menorrhagia? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations, such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 39 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following medical interventions: combined pill, danazol, etamsylate, gonadorelin analogues, intrauterine progesterone, non-steroidal anti-inflammatory drugs (NSAIDs), progestogens, and the following surgical interventions: dilatation and curettage, endometrial destruction, and hysterectomy.
Topics: Administration, Oral; Danazol; Dilatation and Curettage; Endometrial Ablation Techniques; Female; Humans; Intrauterine Devices, Medicated; Menorrhagia; Progestins
PubMed: 22305976
DOI: No ID Found -
Journal of Lower Genital Tract Disease Jan 2023The most recent guidelines for colposcopy practice in the United States, the 2017 Colposcopy Standards Consensus Guidelines, did not include recommendations for...
OBJECTIVE
The most recent guidelines for colposcopy practice in the United States, the 2017 Colposcopy Standards Consensus Guidelines, did not include recommendations for endocervical curettage (ECC). This document provides updated guidelines for use of ECC among patients referred for colposcopy.
METHODS
Consensus guidelines for the use of ECC were developed in 2012. To update these guidelines in concordance with the 2017 Colposcopy Standards process, an expert workgroup was convened in 2021. Literature had been previously reviewed through 2011, before the 2012 guideline. Literature from the years 2012-2021 and data from the NCI Biopsy study were reviewed, focusing on the additional yield of ECC.
RESULTS
Endocervical curettage is recommended for patients with high-grade cytology, human papillomavirus 16/18 infection, positive results on dual staining for p16/Ki67, for those previously treated for known or suspected cervical precancer or considering observation of cervical intraepithelial neoplasia grade 2, and when the squamocolumnar junction is not fully visualized at colposcopy. Endocervical curettage is preferred for all patients aged older than 40 years. Endocervical curettage is acceptable for all nonpregnant patients undergoing colposcopy but may be omitted when a subsequent excisional procedure is planned, the endocervical canal does not admit a sampling device, or in nulliparous patients aged younger than 30 years, with cytology reported as atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion regardless of whether the squamocolumnar junction is fully visualized. Endocervical curettage is unacceptable in pregnancy.
CONCLUSIONS
These guidelines for ECC add to the 2017 consensus recommendations for colposcopy practice in the United States.
Topics: Female; Pregnancy; Humans; Aged; Colposcopy; Cervix Uteri; Curettage; Uterine Cervical Dysplasia; Biopsy; Uterine Cervical Neoplasms
PubMed: 36222824
DOI: 10.1097/LGT.0000000000000710 -
Journal of Orthopaedic Surgery (Hong... Apr 2008To review all patients with chondroblastoma treated in our hospital between 1993 and 2004.
PURPOSE
To review all patients with chondroblastoma treated in our hospital between 1993 and 2004.
METHODS
Six men and 4 women aged 13 to 33 (mean, 21) years with histologically proven chondroblastomas were retrospectively reviewed through our tumour registry, patient records, radiographic and histopathologic reports. All patients underwent intralesional curettage and bone grafting with or without bone cement. The mean follow-up period was 5.5 (range, 2-11.8) years. Functional outcome was measured according to the Enneking scoring system.
RESULTS
The proximal tibia and femur were the most frequently involved sites. All patients presented with pain but only 2 with joint effusion. In 3 patients the lesions were aggressive, in 3 others it was active, and in 4 it was latent. In 2 patients the lesions recurred at 5 and 28 months; both resolved after repeat surgeries without further recurrence. Functional outcomes were either good or excellent, except for one patient with a compartment syndrome of the contralateral leg. No patients had metastasis to lungs or collapse of articular surfaces.
CONCLUSION
Chondroblastoma is a rare benign bone tumour commonly presenting with pain. Outcomes are usually good after curettage and reconstruction with bone grafting.
Topics: Adolescent; Adult; Bone Neoplasms; Bone Transplantation; Cementation; Chondroblastoma; Curettage; Female; Humans; Male
PubMed: 18453666
DOI: 10.1177/230949900801600119 -
Journal of Obstetrics and Gynaecology :... Dec 2023Endocervical sampling is performed traditionally with an endocervical curette (ECC). The current study objective is to compare the histopathological performance of... (Review)
Review
Endocervical sampling is performed traditionally with an endocervical curette (ECC). The current study objective is to compare the histopathological performance of endocervical brush (ECB) and endocervical curette (ECC). A retrospective review was performed including patients included that underwent colposcopy with endocervical sampling using either method. A total of 127 samples were obtained with ECC and 98 with ECB. Histopathological diagnosis was obtained in 124 (97.6%) ECC samples and in 94 (95.9%) ECB samples ( = 0.46). The incidence of benign results was similar between ECC and ECB (117 (92.1%) versus 88 (89.8%) respectively ( = 0.28)). When combining information from endocervical sampling with cervical biopsies, the detection rate of high-grade pathologies was similar between the groups with 14 cases (17.7%) for ECC and 8 cases (17.0%) for ECB ( = 0.43). A scope review of the topic was performed, illustrating that studies favour either method. In conclusion, ECB and ECC perform similarly for providing a histopathological diagnosis on endocervical samples.IMPACT STATEMENT Endocervical samples in colposcopy were traditionally obtained using an endocervical curette. Similarly, a brush can be used for histological sampling of the endocervical canal. However, it is unclear how the ability to obtain a histopathological diagnosis compares between the two techniques. This single-institution experience with using endocervical brush and curette for endocervical sampling finds that both methods are acceptable and have a high ability to provide a histopathological diagnosis. Precisely, 4.1% of brush and 2.4% of curette samples had insufficient tissue. The endocervical brush is an adequate sampling method for colposcopy, and can be safely used instead of the curette, based on clinician preference. Further studies could investigate how these methods compare from a patient perspective.
Topics: Female; Pregnancy; Humans; Cervix Uteri; Vaginal Smears; Specimen Handling; Colposcopy; Curettage; Uterine Cervical Neoplasms; Biopsy; Uterine Cervical Dysplasia
PubMed: 36689210
DOI: 10.1080/01443615.2022.2162866 -
Fertility and Sterility Dec 2018
Topics: Curettage; Dilatation; Female; Humans; Hyaluronic Acid; Prospective Studies; Reproduction
PubMed: 30503114
DOI: 10.1016/j.fertnstert.2018.10.024 -
BMC Musculoskeletal Disorders Aug 2021We reviewed the recent literature related to primary musculoskeletal tumors and metastatic bone tumors. With regard to primary bone tumors, computer navigation systems... (Review)
Review
We reviewed the recent literature related to primary musculoskeletal tumors and metastatic bone tumors. With regard to primary bone tumors, computer navigation systems and three-dimensional-printed prostheses seem to be new treatment options, especially in challenging anatomical locations, such as the sacrum and pelvis. Regarding the treatment of giant cell tumor of bone, recent studies have suggested that denosumab administration is related to a higher local recurrence rate following curettage, but a lower local recurrence rate following en bloc resection. In addition, there was no difference in the local recurrence rate at five years after surgery between short-term and long-term denosumab therapy. With regard to soft tissue tumors, percutaneous cryoablation appears to be a new treatment option for extra-abdominal desmoid tumors, with encouraging results. Regarding soft tissue sarcomas, a negative surgical margin of < 1 mm is sufficient to control local recurrence. Pexidartinib seems to be a promising systemic therapy for the treatment of tenosynovial giant cell tumors for which surgery is not expected to improve the function of the affected limb. Finally, the life expectancy of patients is the most important factor in determining the optimal surgical procedure for patients with impending or pathological fractures of the long bone due to metastatic bone tumors. Elevated C-reactive protein level was found to be an independent poor prognostic factor at 1 year after surgery for long bone metastases.
Topics: Bone Neoplasms; Curettage; Fractures, Spontaneous; Humans; Neoplasm Recurrence, Local; Retrospective Studies; Treatment Outcome
PubMed: 34404379
DOI: 10.1186/s12891-021-04590-1 -
Australian Journal of General Practice Dec 2021Curettage and cautery is a procedure used for treatment of low-risk skin malignancies and pre-cancerous lesions. Given good lesion selection and technique, high cure... (Review)
Review
BACKGROUND
Curettage and cautery is a procedure used for treatment of low-risk skin malignancies and pre-cancerous lesions. Given good lesion selection and technique, high cure rates and good cosmesis are routine for this quick, simple and cost-effective operation.
OBJECTIVE
The purpose of this article is to review and summarise the steps in managing carefully selected cutaneous lesions with curettage and cautery.
DISCUSSION
This article will address lesion selection, technique, efficacy, complications and how to incorporate curettage into daily practice.
Topics: Cautery; Curettage; Humans; Skin Diseases; Skin Neoplasms
PubMed: 34845465
DOI: 10.31128/AJGP-10-20-5695