International Journal of Fertility and Womens Medicine最新文献

In patients with primary breast cancer, the sentinel lymph node biopsy (SLNB) is a minimally invasive method of assessing nodal status, with the aim of reducing the morbidity of axillary lymph node dissection (ALND). The SLNB technique is relatively new, and there are several ongoing clinical trials to assess its long-term effects on survival, local recurrence, and morbidity. Yet, surgeons throughout the United States have already adopted it into their practices, and it is now widely used in the management of patients with primary breast cancer. In this article, we discuss some of the pertinent issues pertaining to the application of SLNB in the management of breast cancer.

Despite the fact that mastectomy remains the safest treatment for ductal carcinoma in situ, breast conserving surgery is still a frequent option. Three randomized trials (NSABP B17- EORTC 10853- UK DCIS) have confirmed a statistically significant reduction of LR rate by the addition of a whole breast irradiation at 50 Gy (RT). The rate of LR, both in situ and invasive, has been reduced by 45-55% with RT, e.g. in the NSABP B-17 trial, with a 129-month follow-up, the overall LR rate decreased from 31.7% to 15.7% (p = 0.001). The RT benefit was confirmed in all subgroups of patients, even with a lack of advantage on survival. Two large retrospective studies (in France and California) also confirmed the benefit of RT after lumpectomy, but with small differences in the subgroup with large excision (and margin width > or = 10 mm). On the other hand, invasive LR can give a 15-20% subsequent metastasis rate. Today, the current whole breast RT using megavoltage photons and provisional CT-scan-based dose distribution is resulting in less than 1% of complications. Until now, no studies have clearly identified patients with a sufficiently low LR risk to justify the lack of RT after lumpectomy. Finally, DCIS treatment requires a close multidisciplinary collaboration; moreover surgery and radiotherapy should be used jointly to obtain optimal long-term local control, such as for so many tumors.

The main controversies surrounding the management of DCIS evolve around the need for adjuvant radiotherapy (RT) after adequate local excision (LE) of localized lesions and the role of adjuvant endocrine therapy. Three recent randomized controlled trials (RCTs) have demonstrated that adjuvant RT significantly reduces the incidence of ipsilateral breast tumor recurrence (IBTR) after "adequate" LE. The role of adjuvant tamoxifen in the treatment of DCIS was evaluated in two RCTs: one demonstrated a significant reduction in IBTR with tamoxifen and the other did not. Retrospective subgroup analysis of the former demonstrated that the reduction in all breast cancer events was even greater for ER positive tumors, but no benefit was observed for ER negative lesions. The effect of tamoxifen was greater in both trials for women under 50 years.

Mammary ductoscopy (MD) allows direct visualization of the mammary ducts using sub-millimetre fiberoptic microendoscopes inserted through the ductal opening onto the nipple surface. MD is a useful diagnostic adjunct in patients with pathological nipple discharge (PND). Furthermore it can reduce the number and extent of duct excision operations for PND. However its potential use in the early detection of breast cancer, guiding breast conserving surgery (BCS) for cancer, therapeutic ablation of intraductal disease, and guiding risk-reducing strategies among high risk women requires further research and evaluation. Future developments include the development of a biopsy kit, combining MD with molecular diagnostic markers and real-time optical biopsy system for the diagnosis of premalignant and early malignant disease and radiofrequency for curative ablation of intraductal lesions.

Pain is one of the most common reasons that patients seek medical care, and affects one-third of the population within a given year. Pain is not always "functional" (physiologic), but often is pathologic, or chronic. This article describes the mechanisms of pain, showing how a protective response can become altered to chronic pain state, such as chronic pelvic pain.

Study objective: To determine the temporal trend of tuberculosis disease among foreign-born children in the State of Florida.

Design and setting: Descriptive population-based study on data obtained from the Tuberculosis Control and Surveillance Program in the State of Florida. We employed Poisson assumption to derive estimates for rates of tuberculosis among US-born and foreign-born children in the studied population. We also applied linear and nonlinear regression equations to describe the best trajectories for observed temporal trends in incidence cases of the disease.

Patients: All cases of tuberculosis disease among children notified in the State of Florida between 1993 and 1999 inclusive.

Main results: The incidence rate of TB over the study period was five times higher among foreign-born children (11.3 per 105; CI = 8.0-14.6 per 105) as compared to US-born (1.7 per 105; CI = 0.8-4.2 per 105). Whereas, new cases of TB among US-born children have continuously and significantly dropped throughout the period of study, our data indicated that the decline achieved from 1993 to 1996 among foreign-born children has ceased, and a resurgence of tuberculosis in this population was apparent.

Conclusions: Our data tend to suggest a re-emergence of tuberculosis among foreign-born children in the State of Florida as from 1997 after several years of decline. There is a need for a more in-depth investigation to elucidate and address causes responsible for the resurgence if the current battle to eliminate tuberculosis from the State is to succeed.

In laparoscopic Filshie clip sterilization, difficulties may arise in identifying the length of the fallopian tube, with the possibility of failure of sterilization. This article describes a novel intraoperative method of demonstrating adequate tubal closure.

Objective: There is a lack of comprehensive information on the relationship between domestic physical and emotional violence and pregnancy outcomes. Accordingly, we undertook this systematic review of the literature to examine the evidence on the association between physical and emotional abuse and pregnancy outcomes.

Study design and method: A comprehensive literature search was carried out using pertinent key words that would retrieve any research article pertaining to the topic. This was supplemented by cross-referencing of the articles. A total of 296 articles were found; case reports and articles that failed to satisfy the study inclusion criteria were removed and 30 articles were included in the review.

Results: Overall, adverse pregnancy outcomes, including low birth weight, maternal mortality and infant mortality are significantly more likely among abused than nonabused mothers. Abused pregnant mothers present more often than nonabused mothers with kidney infections, gain less weight during pregnancy, and are more likely to undergo operative delivery. Fetal morbidity, such as low birth weight, preterm delivery, and small size for gestational age are more frequent among abused than nonabused gravidas. The risk for maternal mortality is three times as high for abused mothers. Black abused mothers are 3-4 times as likely to die as their white counterparts. Unmarried victims are also three times as likely to die as married abused mothers. Intimate partner violence is also responsible for increased fetal deaths in affected pregnancies (about 16.0 per 1000).

Conclusion: Intimate partner violence is often a life-threatening event to both the mother and the fetus. This, in addition to the heightened level of feto-maternal morbidity and mortality, represents clear-cut justification for routine systematic screening for the presence of abuse during pregnancy.

In spite of much ethical uncertainty and wide variations in obstetric and neonatal outcomes reported in the literature, we have studied the outcome of Polish newborns after assisted reproductive technology (ART). In all of our patients, both obstetrics and neonatal care were performed in the Level Three Center in Poznan, Poland. A total of 45 and 82 newborns were analyzed from the ART and the control group, respectively. We analyzed gestational age, birth weight, Apgar score, duration of hospitalization, newborn mortality, and congenital malformations. We found a far higher rate of mothers over 35 years and with university education in ART compared to controls. The incidence of cesarean section and birth weight <1,500 g was much higher in ART. Newborn mortality was much higher among ART newborns compared to controls and was related to premature delivery of triplet pregnancy. The most important factor resulting in high neonatal mortality in our study group was multiple pregnancy. We consider the lack of regulation in Poland concerning the number of replaced embryos as a main factor influencing newborns' outcome after ART.

This commentary highlights controversies associated with the nomenclature of polycystic ovarian disease (PCOD). It also deals with the authors' suggestion for the new name of polyfollicular ovarian disease (PFOD).