Gynecologic Cases Research Articles

Should plain radiographs persist or be replaced by alternative scans for imaging of acute painful non-traumatic abdominal pain?

Purpose: Acute non-traumatic abdominal pain (ANTAP) is a frequent presentation at the emergency department (ED). Plain abdominal radiographs (PAR's) were historically the principal imaging tool. The objective of this study was to determine whether PAR's are still in use for ANTAP diagnosis. The other objective was to determine whether PAR’s stood-alone or were they a redundant step delaying the definitive imaging test. When CT scans were added to PAR's, the sensitivity and specificity of the two modalities were compared. Methods: A report of a retrospective study conducted at an 800-bed hospital ED between 01.06.2014 and 30.06.2014. All patients aged 15 and above who presented with ANTAP and referred first for PAR’s were included. Traumatic, obstetric, gynaecologic cases were excluded. The discharge diagnosis was considered the gold standard. Main findings: The study included 756 patients. 375 (49.6%) were males, 381 (50.4%) were females. The age range was 15 to 92 yrs. Mean age was 46 yrs. The most common presentation was an unclassified abdominal pain in 516 (68%). PAR's were requested alone for 594 (78.5%) and in combination with Conventional CT in 103 (13.6%). Low dose CT was added for 33 (4.3%). The sensitivity of PAR's and CT for urinary stones was 32.8% and 91.3% respectively. The sensitivity of PAR's and CT for intestinal obstruction was 50% and 83.3% respectively. Conclusion: PAR's are still in use as a one-stop shop for imaging the majority of patients presenting with ANTAP. In patients who had both CT and PAR's, there was a low PAR's sensitivity leading to poor congruence in diagnosing abnormal cases. However, CT delivered a higher radiation dose. There is a need to replace the conventional CT and PAR's for ANTAP imaging.

69 - One Institute Experience of Robotic Single-Site Surgery: 500 Cases in Benign Gynecology

69 - One Institute Experience of Robotic Single-Site Surgery: 500 Cases in Benign Gynecology

Operative Learning Needs and Preparation for the Gynecologic Operating Room: A Comparison Between Junior and Senior Residents

BACKGROUND: Differences in operative learning needs and preoperative educational resources utilized by OBGYN residents across postgraduate year (PGY) levels in preparation for gynecologic operative cases are unknown. Understanding these learning needs and preparatory patterns can inform surgical curricula development and address gaps in preparation. METHODS: A cross-sectional survey developed with validity evidence was administered to a registry of 19 OBGYN residency programs. Residents were surveyed on 12 operative learning needs that persisted following routine preoperative preparation and resources utilized to prepare for gynecologic surgical cases and the frequency of use. RESULTS: Participants included 214 residents distributed similarly across PGY levels. The frequency of unmet operative learning needs was consistent across PGY levels with no differences in 8 of 12 topic areas. Junior and senior residents reported a similar ranking of their most frequently unmet operative learning needs in topics of anatomy, patient outcomes, suture selection, and follow-up procedures. No significant differences between junior and senior residents were noted in their regular/frequent use of preparatory educational resources, and more than 90% of both groups reported YouTube as the most commonly accessed web-based resource. DISCUSSION: Despite differences in years of training and surgical case experience, junior and senior residents reported similar unmet operative learning needs and preparatory resource utilization. These findings call for improved alignment in training and identify considerations for future surgical curricula development.

EPIDEMIOLOGICAL INVESTIGATION OF CLINICAL DISEASES AND CONDITIONS OF PET ANIMALS AT CHITTAGONG CITY AREA, BANGLADESH

This study was conducted to estimate the proportional prevalence of clinical diseases and conditions in pet animals (dog, cat, and rabbit) attended at S. A. Quaderi Teaching Veterinary Hospital, Chittagong Veterinary and Animal Sciences University (CVASU), Chittagong, Bangladesh. A total of 388 cases of different clinical diseases and conditions were recorded during the study period from October 2016 toJanuary 2017. Among them the overall proportional prevalence of clinical diseases and conditions in dog, cat and rabbit were 44.32%, 34.28% and 21.39% respectively. The medicinal case comprises the highest percentage of diseases as 79.07% and 66.92% in dog and cat, respectively. Among the medicinal cases parasitic diseases were most frequently encountered both in dog (24.42%) and cat (23.31%). Whereas, prevalence of surgical cases were 16.28% in dog and 31.58% in cat and gynecological cases were 4.65% in dog and 1.50% in cat. In rabbit, prevalence of traumatic injuries and fractures were 16.87% followed by mange 12.06%. The parasitic cases were highest in all of the clinical diseases and conditions. So, proper prevention and therapeutic management should be taken to reduce the prevalence of parasitic diseases of pet animals. Immunoprophylaxis or vaccination and hygienic management should be performed to curb the infectious diseases. Further extensive epidemiologic, laboratory or molecular studies are also needed for the appropriate prevention and control measures of diseases and conditions of pet animals in study area.

P14.14: Acquired uterine arteriovenous malformation (AVM): case series

Uterine AVM although rare, may be acquired after myometrial damage by instrumentation. Pelvic Transvaginal Ultrasound (TVS), gray-scale with colour Doppler and spectral analysis are excellent diagnostics with AVM appearing as subtle heterogeneous hypoechoic myometrial masses with serpinginous mosaic hypervascularity, with low resistance, turbulent vascular flow on Doppler. PSV seems most accurate with a value below .39 m/sec being considered “safe area” and above 0.83 m/sec “dangerous area”. Between 0.40 m/sec and below 0.83 m/sec are “potentially dangerous” according to Timmerman D., Wauters J. et al, Colour Doppler imaging is a valuable tool for the diagnosis and management of UAVM Ultrasound Obstet Gynecol 2003; 21, 570-577. Gold Standard for diagnosis is Angiography, however invasive and reserved for cases needing embolisation, surgery, or both. Presented are 0.14 percent (4/2750 cases) of the total gynecologic cases in 5 years. All presented with profuse vaginal bleeding post curettage. Initial diagnoses were Incomplete Abortion, Endometritis, and Trophoblastic Disease. TVS Indices showed uterine AVM with PSV= 0.55 m/s to 0.7 m/s classified as “Potentially Dangerous”. Three warranted blood transfusion with two undergoing Total Abdominal Hysterectomy with Right Salpingoophorectomy and Bilateral Hypogastric Artery Ligation with endometrial mass excision. Two were stable and underwent Uterine Artery Embolisation (UAE). All repeat TVS with Doppler showed homogeneous myometrium. Clinical courses from time of uterine surgery to diagnosis lasted 1.5 to 8 weeks. Total time from prior obstetric procedure to resolution was 2.7 to 12 weeks. The potential danger of Uterine AVM necessitates careful evaluation and treatment. UAE as conservative therapy is recommended for urgent treatment prior to performing another curettage or surgical procedure, to avoid complications. Total clinical time, from prior obstetric surgical procedure to resolution of disease was 8.5 weeks to 12 weeks proving that UAE is a safe and effective option for conservative management.

Is there a revision needed of the current FIGO staging system?

The FIGO staging system has undergone many modifications since it first appeared in about the middle of the previous century. Due to the use of modern diagnostic tools, namely computed tomography, magnetic resonance imaging, positron emission tomography, sentinel lymph node biopsy and neoadjuvant chemotherapy, certain gynecological cancer cases cannot be allocated to a specific stage if one wishes to adhere strictly to FIGO requirements. In these circumstances such cases actually remain unstaged. This should prompt appropriate modifications of the current FIGO staging system so that it fulfills its aims.

Obstetrical and Gynecological conditions requiring intensive admission from Basra maternity and child hospital A five year survey

Objective:- To assess the obstetrical and gynecological cases admitted to ICU, causes of admission, intervention required, and their morbidity and mortality.Methods :- During the five years period from 1st of Jan 2004 till 1st of Jan 2009, 119 patients were admitted to ICU. Cases were reviewed in detail including age, parity, reason for ICU admission, clinical features, response to intervention and maternal outcome.Result :- mean maternal age was (29.8±6) years the main causes for admission massive bleeding, complications of anesthesia followed by hypertensive disorders of pregnancy (42.8%) (21.8%) (18.4%) respectively, coagulopathy (36.1%) and respiratory failure (26.8%) were the main organ failure, most the admitted patients needed transfusion (50.4%) and ventilatory support (26.50%) specialized intervention like dialysis and surgical intervention were also required (20.1%) .Conclusion:- Invasive hemodynamic monitoring and ventilatory support were the two main interventions, improving quality of care before and after admission to ICU may reduce maternal mortality.

The Analgesic Efficacy of Paracetamol Versus Ketorolac in Day-case Gynaecological Laparoscopic Procedure: A Comparative Study

Background: Gynaecological laparoscopy is a commonly performed procedure. Providing anesthesiafor this can present a challenge, particularly in the day surgery population. Poor analgesia, nausea andvomiting can cause distress to the patient and increased cost for the health system, because of overnightadmission. In this review we discuss anesthetic and analgesic techniques for day case gynaecologicallaparoscopy. Objectives: Our study is undertaken to compare the efficacy of intravenous paracetamol versus ketorolacfor post operative analgesia after gynaecological day case laparoscopic procedures. Method: Sixty (60) female patients 20 – 40 years of age, of ASA I/II were randomized into two equalgroups of 30 patients each. Patients of group A received intravenous paracetamol 1gm and group Breceived intravenous ketorolac 30mg just after induction of general anesthesia. Postoperative pain wasevaluated by standard 10cm linear visual analogue scale (VAS) at different time intervals. When VAS wasmore than 3 rescue analgesic 50mg tramadol intravenously stat was given. Results: In group A that was paracetamol group and group B that was ketorolac group the visual analoguescale (VAS) almost similar but total analgesic consumption in ketorolac group were slightly higher thanparacetamol group. In paracetamol group 4 patients and in ketorolac group 6 patients required rescueanalgesic dose. Conclusion: Our results indicate that IV paracetamol has better analgesic potency than IV ketorolac forpostoperative analgesia after day case gynaecological laparoscopic procedure. JBSA 2017; 30(2): 90-95

Characteristics of Patients with Obstetric and Gynecologic Fistula in Jakarta

Objective: To know the characteristics of patients with obstetrics
 and gynecologic fistula in Dr. Cipto Mangunkusumo Hospital,
 Jakarta.
 
 Method: This study was a descriptive design using secondary data
 from medical records and patient database during 2011-2016.
 
 Result: There were 68 subjects with fistula. From 2011-2016, there
 were 5 cases (7.4%), 19 cases (27.9%), 16 cases (23.5%), 11 cases
 (16.2%), 8 cases (11.8%), and 9 cases (13.2%) of fistula; respectively.
 The average age of subjects was 38 years old and only 34
 subjects have complete data. Gynecologic and obstetric fistula were
 17 cases each. As total 28% of fistula cases were vesicovagina fistula,
 12% were rectovaginal fistula, 9% were anovagina fistula, and the
 other types of fistula were 2%. Among 34 subjects, there were 21%
 of vesicovagina fistula and 3% of rectovagina fistula, which were
 caused by iatrogenic. There were 7% of vesicovagina and rectovagina
 fistula each and 9% of anovagina fistula were caused by
 obstetric problems. The iatrogenic procedures found from this study
 were total abdominal hysterectomy (16%), vaginal hysterectomy
 (3%), and neovagina (3%).
 
 Conclusion: The trend of cases is decreasing during the present
 years (2011-2016). Gynecologic fistula cases caused by iatrogenic
 are the major problems, but the obstetrics fistula cases decreasing
 following the labor monitoring is much better nowadays.
 
 [Indones J Obstet Gynecol 2016; 4-4: 212-217]
 
 Keywords: gynecologic fistula, iatrogenic, obstetric fistula

Patient care needs before and after robotic surgery for gynecologic cases in comparison to laparotomy

Patient care needs before and after robotic surgery for gynecologic cases in comparison to laparotomy

Global Cancer Institute multidisciplinary tumor boards as a tool to improve patterns of clinical practice for breast and gynecologic cancer in resource-limited settings.

6556 Background: Multidisciplinary tumor boards (MTBs) are commonly practiced in high-income countries (HICs) to ensure adherence to guidelines through a team approach to patient care. The Global Cancer Institute (GCI) established online MTBs in 2012 to facilitate live telemedicine discussions of breast and gynecologic case scenarios between specialists in low- and middle-income countries (LMICs) and expert specialists in HICs. GCI MTBs aim to improve clinical knowledge and patterns of practice for specialists in LMICs through an interactive online forum. Methods: In each monthly MTB, three patient case scenarios are presented by specialists in LMICs for live discussion with an expert panel of specialists based in HICs. Guideline or clinical trial-based discussions are held for each case scenario. Best practices for clinical care in limited resource settings are also discussed. Links to clinical practice guidelines, clinical trials, and resources are provided to all MTB attendees. For educational purposes, each MTB is live streamed and uploaded to a private YouTube channel for viewing by community oncologists and trainees worldwide. Results: The GCI MTBs program has recruited over 500 LMIC participants from 48 hospitals in 24 countries across Latin America, Eastern Europe, Africa, and Asia. 17 expert breast cancer specialists and 13 expert gynecologic cancer specialists provide multidisciplinary guidance. To date, 130 breast cancer case scenarios and 80 gynecologic cancer case scenarios have been presented. For breast MTBs, 73% of case scenarios were invasive ductal carcinomas. Common subtypes presented were ER/PR+ (63%), HER2+ (30%), and triple negative disease (28%). 56 cases involved advanced disease management (43%). For gynecologic MTBs, common gynecologic cancer case scenarios were cervical (74%) and ovarian (15%). 37 cases involved advanced disease management (46%). Conclusions: GCI MTBs are a useful educational tool for specialists in LMICs to improve patterns of clinical practice and engage in multidisciplinary discussions. GCI continues to expand its MTBs to cancer facilities in LMICs.

Evidence-based Peer Review for Radiation Therapy – Updated Review of the Literature with a Focus on Tumour Subsite and Treatment Modality

Technological advances in radiation therapy permit steep dose gradients from the target to spare normal tissue, but increase the risk of geographic miss. Suboptimal target delineation adversely affects clinical outcomes. Prospective peer review is a method for quality assurance of oncologists' radiotherapy plans. Published surveys suggest it is widely implemented. However, it may not be feasible to review every case before commencement of radiation therapy in all departments. The rate of plan changes following peer review of cases without a specific subsite or modality is typically around 10%. Stereotactic body radiation therapy, head and neck, gynaecological, gastrointestinal, haematological and lung cases are associated with higher rates of change of around 25%. These cases could thus be prioritised for peer review. Other factors may limit peer review efficacy including organisational culture, time constraints and the physical environment in which sessions are held. Recommendations for peer review endorsed by the American Society for Radiation Oncology were made available in 2013, but a number of relevant studies have been published since. Here we review and update the literature, and provide an updated suggestion for the implementation of peer review to serve as an adjunct to published guidelines. This may help practitioners evaluate their current processes and maximise the utility and effectiveness of peer review sessions.

Narcotic Prescriptions for Benign Gynecologic Procedures in a Tertiary Care Facility [30H

INTRODUCTION: Narcotic addiction has been linked to legal prescription of narcotics by physicians. Narcotic prescriptions for gynecologic surgical procedures vary widely and little data exist to quantify prescribing practices. The present study aimed to describe narcotic prescription practices in gynecologic surgeries. METHODS: We examined gynecologic cases in a retrospective chart review of 8 months from 2014 to 2015. Patient characteristics (age, weight, insurance status, prior narcotic prescription, race, ethnicity, resident team or private physician) and discharge prescription data were collected from 549 cases. Prescriptions were converted into equivalent oral morphine doses for comparison (e.g. 5 mg oxycodone equals 7.5 mg oral morphine). RESULTS: Prescriptions associated with open gynecologic procedures were significantly larger than all other procedure types (P < .001); inpatient laparoscopy prescriptions were larger than any outpatient procedures (P < .001). Mean total prescriptions for surgery categories (in milligrams of oral morphine) were: vulvar and cervical - 90; uterine (e.g. hysteroscopy, dilation and curettage) - 50; outpatient laparoscopy - 137; inpatient laparoscopy and vaginal surgery - 267; and open - 323. No significant differences were correlated to age, weight, race, insurance, or care team. Of note, 43% of patients had a narcotic prescription in the five years preceding surgery. CONCLUSION: Narcotic prescription practices are widely varied, and significantly different between procedure types. Many patients have prescription narcotic exposure prior to a gynecologic procedure. More study is needed to evaluate how much narcotic patients utilize for gynecologic procedures to avoid excessive prescribing.

Comparison of the Induction and Recovery Characteristics of Propofol and Thiopentone Sodium for Gynaecological Diagnostic Day Case Laparoscopies

Comparison of the Induction and Recovery Characteristics of Propofol and Thiopentone Sodium for Gynaecological Diagnostic Day Case Laparoscopies

Expression of protease-activated receptor-2 (PAR-2) is related to advanced clinical stage and adverse prognosis in ovarian clear cell carcinoma

Recent studies demonstrated that protease-activated receptor-2 (PAR-2) correlates with tumor progression in various tissues. On the other hand, oxidative stress arising from endometriosis has been considered a cause of carcinogenesis in ovarian clear cell carcinoma (OCCC). We previously demonstrated that oxidative stress up-regulates PAR-2 expression, and we conducted the present study to investigate the PAR-2 expression and its relation to clinicopathological factors and oxidative stress in OCCC. We performed an immunohistochemical evaluation in 95 cases of OCCC. For the evaluation of oxidative stress markers, 31 cases of ovarian endometrioid carcinoma (OEC) were also examined. No significant differences in the expression of cyclooxygenase-2 and inducible nitric oxide synthase were observed between OCCC and OEC. Sixty-two percent of the OCCC cases showed high 8-hydroxydeoxyguanosine expression, whereas all of the OEC cases showed almost negative immunoreactivities. The presence of endometriosis did not affect the expression of these oxidative stress markers or prognosis. High PAR-2 expression was observed in 20% (14/71) of the early International Federation of Gynecology and Obstetrics (FIGO) stage cases and 58% (14/24) of the advanced FIGO stage cases. High PAR-2 expression was significantly correlated with advanced FIGO stage and shorter overall survival. We found no correlations between PAR-2 expression and oxidative stress in OCCC. Our results suggest that PAR-2 plays an important role in the progression of OCCC. The expression of 8-hydroxydeoxyguanosine is a characteristic finding of OCCC, indicating that the injury of DNA by oxidative stress may be involved in the carcinogenesis of OCCC.

Magnetic resonance-only simulation and dose calculation in external beam radiation therapy: a feasibility study for pelvic cancers

Background: The clinical feasibility of using pseudo-computed tomography (pCT) images derived from magnetic resonance (MR) images for external bean radiation therapy (EBRT) planning for prostate cancer patients has been well demonstrated. This paper investigates the feasibility of applying an MR-derived, pCT planning approach to additional types of cancer in the pelvis.Material and methods: Fifteen patients (five prostate cancer patients, five rectal cancer patients, and five gynecological cancer patients) receiving EBRT at Turku University Hospital (Turku, Finland) were included in the study. Images from an MRCAT (Magnetic Resonance for Calculating ATtenuation, Philips, Vantaa, Finland) pCT method were generated as a part of a clinical MR-simulation procedure. Dose calculation accuracy was assessed by comparing the pCT-based calculation with a CT-based calculation. In addition, the degree of geometric accuracy was studied.Results: The median relative difference of PTV mean dose between CT and pCT images was within 0.8% for all tumor types. When assessing the tumor site-specific accuracy, the median [range] relative dose differences to the PTV mean were 0.7 [−0.11;1.05]% for the prostate cases, 0.3 [−0.25;0.57]% for the rectal cases, and 0.09 [−0.69;0.25]% for the gynecological cancer cases. System-induced geometric distortion was measured to be less than 1 mm for all PTV volumes and the effect on the PTV median dose was less than 0.1%.Conclusions: According to the comparison, using pCT for clinical EBRT planning and dose calculation in the three investigated types of pelvic cancers is feasible. Further studies are required to demonstrate the applicability to a larger cohort of patients.

FDG PET/CT Pitfalls in Gynecologic and Genitourinary Oncologic Imaging.

The role of whole-body positron emission tomography (PET)/computed tomography (CT) with fluorodeoxyglucose ( FDG fluorodeoxyglucose ) is now established in the assessment of many gynecologic and genitourinary malignant tumors. FDG fluorodeoxyglucose PET/CT has been widely adopted for staging assessments in patients with suspected advanced disease, in cases of suspected disease recurrence, and for determining prognosis in a number of malignancies. A number of pitfalls are commonly encountered when reviewing FDG fluorodeoxyglucose PET/CT scans in gynecologic and genitourinary cases; these pitfalls can be classified into those that yield potential false-positive or false-negative results. Potential false positives include physiologic uptake of FDG fluorodeoxyglucose by the endometrium and ovaries in premenopausal patients, physiologic renal excretion of FDG fluorodeoxyglucose into the ureters and the urinary bladder, and increased FDG fluorodeoxyglucose activity in benign conditions such as uterine fibroids, pelvic inflammatory disease, and benign endometriotic cysts. Potential false negatives include low-level FDG fluorodeoxyglucose uptake by necrotic, mucinous, cystic, or low-grade tumors and the masking of serosal and peritoneal disease by adjacent physiologic bowel or bladder activity. In addition, there are inherent technical limitations-such as motion artifact (from respiratory motion and bowel peristalsis) and the limited spatial resolution of PET-that may limit the assessment of small-volume malignant disease. Knowledge of the key imaging features of physiologic and nonphysiologic FDG fluorodeoxyglucose uptake, in addition to understanding the principles of adequate patient preparation and PET scanning protocols, is important for accurate interpretation of gynecologic and genitourinary oncologic FDG fluorodeoxyglucose PET/CT studies. ©RSNA, 2017.

Abstract P2-02-05: Comparison of non-breast and ovarian cancer phenotypes of BRCA1/2 mutation carriers across multi-gene panels

Abstract Background: BRCA1/2 germline mutations account for the majority of hereditary breast and ovarian cancers. Until 2013, the only way to identify individuals with BRCA mutations was through single gene testing. With multi-gene panel testing (MGPT) including BRCA1/2, BRCA mutations are being identified at an increased rate. To date, the phenotype of BRCA1/2 mutation carriers includes an increased prevalence of breast, ovarian, prostate, and pancreatic cancer, as well as melanoma. The phenotype, however, of mutation carriers identified by panel testing is not well understood. Methods: All sequential cases submitted to our laboratory for MGPT including BRCA1/2 between June 2013 and June 2015 and BRCA1/2 single gene testing between June 2013 and February 2015 were retrospectively reviewed. Data from 77,345 test request forms were reviewed; probands with a BRCA1 or BRCA2 mutation were selected and analyzed. Probands with no personal history of cancer/not provided (n=528) were excluded. Results: Of 2,967 BRCA1/2 positive probands, 2,439 (82.2%) had a personal history of cancer, with 2,794 cancers reported. On all tests completed, with the exception of a pancreatic cancer focused panel, breast and/or ovarian cancer were the most commonly observed cancer types (n=2,364, 84.6%). On single gene testing (n=739), prostate (n=16, 2.2%), colorectal (n=8, 1.1%), and pancreatic (n=7, 0.9%) cancers were the other most frequent cancers reported. Across all MGPT cases (n=1,700), additional observed cancers included uterine (n=48, 2.8%), colorectal (n=46, 2.7%), pancreatic (n=37, 2.2%), melanoma (n=29, 1.7%), and thyroid (n=27, 1.6%). For breast cancer-specific gene panel cases (n=934), additional cancers included thyroid (n=12, 1.3%) and uterine cancer (n=10, 1.1%). For gynecologic cancer gene panel cases (n= 482), additional cancers included uterine (n=21, 4.4%), colorectal (n=11, 2.3%), and melanoma (n=11, 2.3%). Cases tested via a pancreatic cancer gene panel (n=25,) had pancreatic cancer (n=17, 68%) reported most frequently, followed by breast (n=6, 24%), colorectal (n=3, 12%), and melanoma (n=3, 12%). For comprehensive cancer gene panel cases (n=254), colorectal (n=28, 11.0%), uterine (n=17, 6.7%), pancreatic (n=14, 5.5%), prostate (n=10, 3.9%), thyroid (n=10, 3.9%), and a variety of rare tumor types (n=15, 5.9%) were among the additional cancers reported. Discussion: As expected, the majority of cancers reported on almost all tests were breast and/or ovarian cancer. More specifically, the observed cancers for tumor specific cancer panels, matched the relevant cancer type (i.e. pancreatic cancer most commonly reported in those tested via a pancreatic cancer panel). However, on the comprehensive cancer panels, other than breast and ovarian cancer, there appears to be a more even distribution of various cancer types, including rare tumors, in probands who have a BRCA1 or BRCA2 mutation. Further studies should be conducted to examine the phenotypes of BRCA mutation carriers identified via comprehensive cancer panels to determine the association and prevalence of unexpected cancer types with BRCA1/2 mutations. This could have important implications for determining the most appropriate genetic test and management of BRCA mutation carriers. Citation Format: Jackson M, Yusuf A, Espenschied C, Paudyal T, Profato-Partlow J. Comparison of non-breast and ovarian cancer phenotypes of BRCA1/2 mutation carriers across multi-gene panels [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-02-05.

К вопросу о возможности аллогенной плацентарной терапии постовариоэктомических проявлений у больных, отягощенных гинекологическим раком, после противоопухолевого лечения

The results of a clinical-psychological prospective examination of 131 patients with cervical cancer, the uterus body and ovaries of stage I-III according to FIGO, reproductive age in total hysterovectomy and radiation suppression of ovaries isolated in three clinical groups are presented: group I - patients after combined and complex special treatment; Group II - patients after combined radiation treatment and group III - patients after combined and complex treatment, therapy of postovariochemical manifestations of which was carried out by traditional therapy. Identification of personal resources of stress-resistance was carried out using the copy-test of R.Lazarus. The intensity of oxidative processes in blood plasma was judged by the content of their carbonyl derivatives, revealed in the reaction with 2,4-dinitrophenylhydrazine. Results and discussion. For patients in the state of total hysterovarioectomy (groups I and III), the hyperactivity of the strategy Confrontation (76.8% and 76.4%, respectively) and Positive revaluation (67.8% and 72.6%) are a common phenomenon. Constructive strategies; Distant (73.8%) and Acceptance of responsibility (82.5%) are typical for patients of the II group who are in drug and radiation suppression. In the blood of all patients, increased oxidative potential was determined. Significant changes were demonstrated in the analysis of the intensity of induced (metal-catalyzed) OMB: at λ 370 nm and λ 530 nm in group I and group III (p<0.01): the level of oxidation products was significantly lower in the group II patients after SLT. Changes were demonstrated in the analysis of the intensity of induced (metal-catalyzed) OMB. The level of carbonyl groups was significantly lower in the group of patients II after SLT (p<0.01). After the therapy with allogeneic hydrolyzate of the placenta (AHP) with Melsmon of the APEC for 14 weeks, an objective orientation toward a decrease in the oxidative potential in the blood of patients was manifested. The serum level of the end products of OMB had an active decrease in comparison with the similar values in group I at λ 370 nm (1.3 times) and λ 430 nm (1.5 times); p<0.01. At λ 530 nm - groups I decrease by 1.4 times and II decrease by 1.6 times, p<0.01. The level of OMB in induced oxidation demonstrated a pronounced active decrease, especially at λ 530 (p<0.01). The study of induced AMB in the serum of Group III patients with gynecological cancer, the treatment of which was carried out by traditional methods in the PES did not show any statistical differences. In group I patients, the activity of non-constructive strategies is significantly reduced: confrontation (from 76.8% to 54.2%); flight/avoidance (from 64.2% to 38.6%). More actively, patients began to apply resources to constructive distancing strategies (activity increased from 42.4% to 68.3%); planning of problem solving (from 42.8% to 72.4%). The active decrease in the level of the carbonyl products of protein oxidation correlated with the improvement and stabilization of the psychological status in the form of non-constructive coping strategies Confrontation, Escape-avoidance in patients of group I (r=0.379, r=0.437, p<0.001) and group II (r=0.439, r=0.376, p<0.001). Conclusions. 1. In gynecological cancer cases examined in the PES state , there is an intensification of the processes of free radical oxidation of biomolecules. However, in patients with preserved ovaries, the oxidative processes are somewhat reduced. 2. Decrease in the levels of carbonyl oxidation products against the background of Melsmon therapy in patients with gynecological cancer in the state of PES testifies to the possibility of participation of the drug components in antiradical protection. 3. Evaluation of the results of sonographic monitoring of the abdominal and pelvic organs in patients included in the study did not reveal a worsening of the prognosis of the underlying disease against the background of allogeneic placental therapy. 4. Allogeneic placental therapy with Melsmon helps to improve the psychological status of gynecological cancer patients in the form of stress-overcoming.

Multidisciplinary Team Approach for the Management of Severe Deeply Infiltrating Endometriosis

Introduction: Colorectal endometriosis results in alterations of bowel habit and rectal bleeding (rarely). Evaluation of the disease process and subsequent surgical planning is via a multidisciplinary team approach. Aim: The aim of our study is to analyze the gynecological endometriosis work load to assess colorectal involvement acquired. Methods: This was a retrospective observational study. Data was collected from theatre records, MDT outcomes, clinical records, HIPE system and postoperative pathological findings. Inclusion criteria were those with documented clinical and imaging diagnosis of deep pelvic endometriosis. Patients diagnosed with endometriosis who underwent surgical management were reviewed. We analyzed the colorectal work load required in surgical approach in deeply penetrating endometriosis. Results: Total of 28 women (mean age 39, range 26-56), over 3 years period (Jan 2014- Jan with diagnosis of Stage IV endometriosis who had undergone surgical intervention were included in our analysis. A clear majority have complained of pelvic pain (on defecationespecially perimenstrually). Operations included were anterior resection (6), sigmoid colectomy (1), rectovaginal fistula repair (1), appendectomy (1), adhesiolysis (3), and hysterectomy with or without bilateral salphingo-oophorectomy (16). About 42% of the cases had colorectal surgeon’s involvement, adhesiolysis or complicated procedure such as anterior resection. Conclusion: Colorectal input is required in significant volume in gynecological endometriosis cases. Studies have shown the surgical treatment of DIE is complex and subject to complications. The surgical expertise of a multidisciplinary team plays a vital role in this setting. For patient safety and medico legal cases it is important to have MDT approach.