Current opinion in gynecology and obstetrics最新文献

{"title":"Technique of Breast Reconstruction with Expander Implants after Mastectomy","authors":"S. Krämer, M. Friedrich, C. Kraft","doi":"10.18314/cogo.v1i1.1275","DOIUrl":"https://doi.org/10.18314/cogo.v1i1.1275","url":null,"abstract":"The reconstruction of the female breast after mastectomy is an integral part of the surgical treatment of breast cancer nowadays. If it is necessary for oncologic reasons and if there are contraindications for breast conserving therapy, methods of breast reconstruction can contribute significantly to the restoration of physical integrity, including an improvement of life quality for the affected women. Besides an improvement or restoration of the physical image and of the self-esteem, breast reconstruction leads to a processing of an oncologically necessary mastectomy from a psychooncological and rehabilitative point of view. Alloplastic methods of breast reconstruction are the most common methods of reconstructing the female breast after mastectomy. In order to obtain optimal results from reconstruction, the use of textured, anatomically shaped expander-implant systems are recommended. After modified radical mastectomy a combined expander implant reconstruction can be indicated to reconstruct a smaller, non-ptotic breast after preforming stretching of the skin. This combined expander-implant reconstruction can be performed primarily during mastectomy as well as secondarily. If adjuvant therapy is necessary, especially in the case of radiation therapy, an implant or expander-implant reconstruction is relatively contraindicated because of an insufficiently high rate of complication. The patients need to be informed about the very often necessity of adapting mastopexy or reduction mastopexy of the contralateral breast and about possible autologous methods of reconstruction. In our opinion, adjuvant radiation therapy is a contraindication for alloplastic reconstruction because of an inacceptable complication rate, especially if compared to autologous reconstruction. Therefore, primary alloplastic reconstruction should be indicated very critically. When planning alloplastic or, of course, autologous breast reconstruction the overall oncological situation of the patient needs to be considered. To avoid prognostic or aesthetic disadvantages, the differential indication for the methods of breast reconstruction should ideally take place in specialized breast centres with experience in all methods of reconstruction.","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85484822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ductus Venosus Agenesis and Fetal Malformations: Report of Four Cases","authors":"A. Matias, Diana Pacheco, O. Brandão, N. Montenegro","doi":"10.18314/COGO.V1I1.1272","DOIUrl":"https://doi.org/10.18314/COGO.V1I1.1272","url":null,"abstract":"Background: The agenesis of the ductus venosus (DVA) is a rare condition with a variable prognosis that relies partly on the presence of associated conditions. Therefore, the prenatal evaluation should include a careful examination of fetal circulation, particularly the umbilical and portal venous malformations.Methods In this study, we describe four cases of DVA diagnosed at our institution. For each case, we access the patient’s files in order to extract the following information: gestational age, umbilical vein connection, pre-natal imaging findings, gestational age at delivery or at pregnancy termination, fetal outcomes, post-natal imaging findings, post-mortem findings and karyotype.Results From the four cases included, two were diagnosed in the first trimester and the other two cases in the second trimester of gestation. Prenatal ultrasound studies revealed an intrahepatic shunt in one case and an extrahepatic shunt in three cases. In one case, the karyotype was not performed, whereas the other three had a normal karyotype. Cardiac anomalies were found in three of the four fetuses. All but one case presented with extracardiac abnormalities. None of the cases developed hydrops. Two cases are currently alive and well, one termination of pregnancy occurred at 25 weeks of gestation and one case died at 14 days during surgical correction of a complex cardiac malformation.Conclusions Clinicians should be aware of different and important findings during the fetal examination, which can be indicative of a DVA, and, when suspected, serial revaluations should be scheduled in order to identify any malformation.","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89253675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transgender Health Simplified: A Concise Guide to the Gynecologist","authors":"Mikdachi H, Mann L","doi":"10.18314/cogo.v1i1.1209","DOIUrl":"https://doi.org/10.18314/cogo.v1i1.1209","url":null,"abstract":"Most healthcare providers, gynecologists included, will encounter, care for and treat transgender patients. As such, gynecologists should be familiar with the basics of transgender care. This includes knowing how to create a trans-friendly clinic environment, knowing and adhering to screening guidelines, understanding the basics of cross hormone therapy and sex reassignment surgery. This article will review these topics, and other, that can allow the gynecologist to offer the best care to her/his transgender patients.","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78843925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Size Matters: Contemporary use of the IUD","authors":"E. Levine, C. Fernandez","doi":"10.18314/COGO.V1I1.1145","DOIUrl":"https://doi.org/10.18314/COGO.V1I1.1145","url":null,"abstract":"Long-acting reversible contraceptive choices are becoming more popular among young women, and providers may need to keep in mind those methods that are likely to be most successful.  The dimensions of the uterine cavity vary according to the parity of a user, with the nulliparous woman having a smaller uterine space.  With the known intrauterine contraceptive device side effects being possible, and with smaller such devices being clinically available for patients, selection of those smaller devices for contraceptive use may be more ideal for those younger nulliparous women.  In this way, complications with this method may possibly be avoided.   \u0000 ","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"140 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80010429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ovarian tissue cryopreservation from contemporary indications to cutting edge research","authors":"L. Man, Z. Rosenwaks, D. James","doi":"10.18314/cogo.v1i1.1100","DOIUrl":"https://doi.org/10.18314/cogo.v1i1.1100","url":null,"abstract":"Over the last three decades, survival rate from malignancies has steadily increased, turning major focus on quality of life in remission. Unfortunately, a major side effect of medical interventions including chemotherapy, radiotherapy, and/or surgery is premature ovarian failure and infertility for many patients. Ovarian tissue cryopreservation is an experimental technique used to preserve reproductive potential in patients who are pre-pubertal, must urgently undergo gonadotoxic treatment or who have other medical conditions requiring treatment that may undermine ovarian reserve and will lead to sub or infertility. We will review the indications, available techniques of tissue harvesting, and methods for freezing and autotransplanting cortical ovarian tissue. We will discuss outcomes, the potential risk of reintroducing malignancy and lastly, cutting-edge research models being developed in the field.","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86513286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Saving the Fetus in Maternal Schizophrenia: The Role and Safety of Electroconvulsive Therapy (ECT) in Pregnancy.","authors":"Othman Abdul Karim, Noraslawati R, Anisah J, Syaratul Emma H","doi":"10.18314/cogo.v1i1.1071","DOIUrl":"https://doi.org/10.18314/cogo.v1i1.1071","url":null,"abstract":"Introduction: Managing schizophrenia during pregnancy often presents a clinical dilemma. Although pharmacological interventions are mostly effective for these disorders during pregnancy, there are few drawbacks for this approach. The potential teratogenicity and long duration of interventions required to control the symptoms somehow limits its usage during pregnancy.Here we described a case report of treatment-resistant schizophrenia successfully treated with ECT without obvious complication to the mother and her baby.Conclusion: Electroconvulsive therapy is an ideal alternative treatment for a patient with schizophrenia during pregnancy. ECT also will eliminate the potential side effects of antipsychotic medications on the mother and teratogenicity effect to the fetus, especially during the first trimester.","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89118390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Hispanic Ethnicity with Nonalcoholic Fatty Liver Disease in Polycystic Ovary Syndrome.","authors":"Monika Sarkar,&nbsp;Norah Terrault,&nbsp;Caroline C Duwaerts,&nbsp;Phyllis Tien,&nbsp;Marcelle I Cedars,&nbsp;Heather Huddleston","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Polycystic Ovary Syndrome (PCOS) affects 10-15% of reproductive age women and is a recognized risk factor for nonalcoholic fatty liver disease (NAFLD). The more severe form of NAFLD, known as nonalcoholic steatohepatitis (NASH), results in liver inflammation with or without fibrosis, and is now a leading cause of cirrhosis. Ethnic differences are apparent in NAFLD, with higher prevalence in Hispanics, although the role of Hispanic ethnicity on risk for NAFLD/NASH in women with PCOS is not known.</p><p><strong>Objective: </strong>The aim of this study was to evaluate ethnic differences in the prevalence and risk of NAFLD/NASH in women with PCOS.</p><p><strong>Study design: </strong>Among PCOS women followed in a large academic medical center the association of Hispanic ethnicity with elevated biomarkers of NASH, including plasma cytokeratin 18 (CK18) M30 fragments and/or ALT levels (n=303), was assessed. Prevalence of hepatic steatosis by Controlled Attenuation Parameter (CAP) imaging was also evaluated in a subset of PCOS women (n=35).</p><p><strong>Results: </strong>The median cohort age (n=303) was 28 years (IQR 8), and 15.5% (n=47) were Hispanic, the majority of whom reported white race (94%). Most Hispanic women had hepatic steatosis on imaging, which was markedly higher than in non-Hispanics (83% vs 24%, p=0.005). Approximately 17% of PCOS women had elevated ALT or elevated CK18, which was more common in Hispanics than non-Hispanics, at 34% vs 14%, respectively, p=0.002. On univariate analysis, Hispanic ethnicity was associated with two-fold higher odds of NASH (OR 2.0, 95% CI 1.0-3.9, p=0.038), and the association persisted after adjustment for HOMA-IR and waist circumference (AOR 3.1, 95% CI 1.1-8.9, p=0.034).</p><p><strong>Conclusion: </strong>NAFLD/NASH is an important condition to be considered by PCOS providers and Hispanic women with PCOS are a particularly high-risk group that may warrant routine screening.</p>","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"1 1","pages":"24-33"},"PeriodicalIF":0.0,"publicationDate":"2018-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089370/pdf/nihms978094.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36402435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Hispanic Ethnicity with Nonalcoholic Fatty Liver Disease in Polycystic Ovary Syndrome.","authors":"M. Sarkar, N. Terrault, Caroline C. Duwaerts, P. Tien, M. Cedars, H. Huddleston","doi":"10.18314/COGO.V1I1.999","DOIUrl":"https://doi.org/10.18314/COGO.V1I1.999","url":null,"abstract":"Polycystic Ovary Syndrome (PCOS) affects 10-15% of reproductive age women and is a recognized risk factor for nonalcoholic fatty liver disease (NAFLD). The more severe form of NAFLD, known as nonalcoholic steatohepatitis (NASH), results in liver inflammation with or without fibrosis, and is now a leading cause of cirrhosis. Ethnic differences are apparent in NAFLD, with higher prevalence in Hispanics, although the role of Hispanic ethnicity on risk for NAFLD/NASH in women with PCOS is not known.\u0000\u0000\u0000OBJECTIVE\u0000The aim of this study was to evaluate ethnic differences in the prevalence and risk of NAFLD/NASH in women with PCOS.\u0000\u0000\u0000STUDY DESIGN\u0000Among PCOS women followed in a large academic medical center the association of Hispanic ethnicity with elevated biomarkers of NASH, including plasma cytokeratin 18 (CK18) M30 fragments and/or ALT levels (n=303), was assessed. Prevalence of hepatic steatosis by Controlled Attenuation Parameter (CAP) imaging was also evaluated in a subset of PCOS women (n=35).\u0000\u0000\u0000RESULTS\u0000The median cohort age (n=303) was 28 years (IQR 8), and 15.5% (n=47) were Hispanic, the majority of whom reported white race (94%). Most Hispanic women had hepatic steatosis on imaging, which was markedly higher than in non-Hispanics (83% vs 24%, p=0.005). Approximately 17% of PCOS women had elevated ALT or elevated CK18, which was more common in Hispanics than non-Hispanics, at 34% vs 14%, respectively, p=0.002. On univariate analysis, Hispanic ethnicity was associated with two-fold higher odds of NASH (OR 2.0, 95% CI 1.0-3.9, p=0.038), and the association persisted after adjustment for HOMA-IR and waist circumference (AOR 3.1, 95% CI 1.1-8.9, p=0.034).\u0000\u0000\u0000CONCLUSION\u0000NAFLD/NASH is an important condition to be considered by PCOS providers and Hispanic women with PCOS are a particularly high-risk group that may warrant routine screening.","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"12 1","pages":"24-33"},"PeriodicalIF":0.0,"publicationDate":"2018-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73068428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic surgery for pelvic support defects","authors":"J. Miklos, Robert D Moore, N. Kohli","doi":"10.1097/00001703-200208000-00005","DOIUrl":"https://doi.org/10.1097/00001703-200208000-00005","url":null,"abstract":"Reconstructive pelvic surgery for the treatment of vaginal prolapse continues to evolve as surgeons continue their quest for definitive surgical cure. Though there are three primary routes of access to reconstructive pelvic surgery (abdominal, vaginal and laparoscopic) it is the laparoscopic approach that appears to be the least utilized. This is in part due to the great degree of technical difficulty associated with laparoscopic suturing. This paper reviews the general principles and functional anatomy associated with normal vaginal support as well as the laparoscopic surgical approach to pelvic floor support defects.","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"1 1","pages":"387-395"},"PeriodicalIF":0.0,"publicationDate":"2002-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86483997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bacterial vaginosis in pregnancy","authors":"A. Ugwumadu","doi":"10.1097/00001703-200204000-00003","DOIUrl":"https://doi.org/10.1097/00001703-200204000-00003","url":null,"abstract":"Bacterial vaginosis is associated with adverse pregnancy outcomes across all gestational ages. It is linked to first and second trimester fetal loss, chorioamnionitis, preterm delivery, low-birthweight infants and maternal/neonatal infectious morbidity. Infants who survive preterm birth are at an increased risk of subsequent neurodevelopmental delays and handicap, more so if there was underlying choriomnionitis. The exact mechanisms and pathways through which bacterial vaginosis exerts these adverse effects are incompletely understood. Not surprisingly, intervention studies in bacterial vaginosis-positive pregnant women have shown conflicting results, both in women at high and low risk of preterm birth. A much better understanding of the pathobiology of bacterial vaginosis in pregnancy is required to focus the designs of intervention studies on the disturbed cellular and biochemical pathways. Such studies may address the benefits of the treatment of bacterial vaginosis before conception and during early pregnancy, to determine whether treatment in populations of pregnant women may be beneficial.","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"6 1","pages":"115-118"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75477208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}