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| 2. |
- Bollino, Michele, et al.
(författare)
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Pelvic sentinel lymph node biopsy in endometrial cancer- A simplified algorithm based on histology and lymphatic anatomy
- 2020
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Ingår i: International Journal of Gynecological Cancer. - : BMJ. - 1048-891X .- 1525-1438. ; 30:3, s. 339-345
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To achieve the full potential of sentinel lymph node (SLN) detection in endometrial cancer, both presumed low- A nd high-risk groups should be included. Perioperative resource use and complications should be minimized. Knowledge on distribution and common anatomical sites for metastatic SLNs may contribute to optimizing the concept while maintaining sensitivity. Proceeding from previous studies, simplified algorithms based on histology and lymphatic anatomy are proposed. Methods: Data on mapping rates and locations of pelvic SLNs (metastatic and non-metastatic) from two previous prospective SLN studies in women with endometrial cancer were retrieved. Cervically injected indocyanine green was used as a tracer and an ipsilateral re-injection was performed in case of non-display of the upper and/or lower paracervical pathways. A systematic surgical algorithm was followed with clearly defined SLNs depicted on an anatomical chart. In high-risk endometrial cancer patients, removal of SLNs was followed by a pelvic and para-aortic lymphadenectomy. Results: 423 study records were analyzed. The bilateral mapping rates of the upper and lower paracervical pathways were 88.9% and 39.7%, respectively. 72% of all SLNs were typically positioned along the upper paracervical pathway (interiliac and/or proximal obturator fossa) and 71 of 75 (94.6%) of pelvic node positive women had at least one metastatic SLN at either of these positions. Women with grade 1-2 endometroid cancers (n=275) had no isolated metastases along the lower paracervical pathway compared with two women with high-risk histologies (n=148). Conclusion: SLNs along the upper paracervical pathway should be identified in all endometrial cancer histological subtypes; removal of nodes at defined typical positions along the upper paracervical pathway may replace a site-specific lymphadenectomy in case of non-mapping despite tracer re-injection. Detection of SLNs along the lower paracervical pathway can be restricted to high-risk histologies and a full pre-sacral lymphadenectomy should be performed in case of non-display.
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| 3. |
- Dancet, Eline A F, et al.
(författare)
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The Role of Scientists and Clinicians in Raising Public Support for Animal Research in Reproductive Biology and Medicine.
- 2012
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Ingår i: Biology of reproduction. - : Oxford University Press (OUP). - 1529-7268 .- 0006-3363.
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Tidskriftsartikel (refereegranskat)abstract
- It is important that researchers active in reproductive animal research, as a group, clearly and compassionately convey specific information to students, patients, and the general public on the merit and need for biomedical research using various formats and seek active support from patient organizations, universities, politicians, celebrities, the media, and international professional organizations related to human and animal health.
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| 4. |
- Ekdahl, Linnea, et al.
(författare)
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A combination of second trimester oral metronidazole and no sexual intercourse during second and third trimester may reduce late miscarriage and premature delivery after fertility sparing radical trachelectomy
- 2021
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Ingår i: European Journal of Obstetrics and Gynecology and Reproductive Biology. - : Elsevier BV. - 0301-2115 .- 1872-7654. ; 265, s. 90-95
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Women with a previous trachelectomy have an increased risk of premature delivery and second trimester miscarriage. In this study we aim to evaluate factors and regimes possibly affecting the risk for prematurity following fertility sparing robotic radical trachelectomy (RRT) in cervical cancer. Methods: A retrospective study of the reproductive outcome following RRT with a cervical cerclage performed at one of four academic centers between 2007 and 2019. Factors possibly related to premature delivery, such as postoperative non-pregnant cervical length, previous vaginal deliveries, preservation of the uterine arteries, and the use of a second trimester oral metronidazole/no sexual intercourse regime, were assessed. Results: 109 women remained for analyses after excluding recurrences before pregnancy (n = 8), secondary hysterectomy (n = 2), and women with less than six months follow up (n = 10). 74 pregnancies occurred in 52/71 women attempting to conceive, 56 of which developed past the first trimester. Two of 22 women (9%) who were prescribed an oral metronidazole regime (400 mg × 2 from gestational week 15 + 0 to 21 + 6 and abstaining from sexual intercourse for the duration of the pregnancy) had a premature delivery, compared with 13/31 (42%) where the regime was not applied (p = 0.009). The association remained after regression analyses including possible contributing factors as of above, none of which associated with prematurity at regression analyses (p = 0.001). Conclusions: The observed four-fold reduction in premature delivery indicates that an oral metronidazole/no sexual intercourse regime may reduce second trimester miscarriage and premature deliveries following an RRT. No association was observed for other investigated factors.
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| 5. |
- Ekdahl, Linnea, et al.
(författare)
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Increased Institutional Surgical Experience in Robot-Assisted Radical Hysterectomy for Early Stage Cervical Cancer Reduces Recurrence Rate: Results from a Nationwide Study
- 2020
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Ingår i: JOURNAL OF CLINICAL MEDICINE. - : MDPI AG. - 2077-0383. ; 9:11
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the impact of institutional surgical experience on recurrence following robotic radical hysterectomy (RRH) for early stage cervical cancer. All women in Sweden who underwent an RRH for stage IA2-IB1 cervical cancer at tertiary referral centers from its implementation in December 2005 until June 2017 were identified using a Swedish nationwide register and local hospital registers. Registry data were controlled by a chart review of all women. Recurrence rates and patterns of recurrence were compared between early and late (<= 50 vs. >50 procedures) institutional series. Six hundred and thirty-five women were included. Regression analysis identified a lower risk of recurrence with increased experience but without a clear cut off level. Among the 489 women who did not receive adjuvant radio chemotherapy (RC-T), the rate of recurrence was 3.6% in the experienced cohort (>50 procedures) compared to 9.3% in the introductory cohort (p < 0.05). This was also seen in tumors < 2 cm regardless of RC-T (p < 0.05), whereas no difference in recurrence was seen when analyzing all women receiving RC-T. In conclusion, the rate of recurrence following RRH for early stage cervical cancer decreased with increased institutional surgical experience, in tumors < 2 cm and in women who did not receive adjuvant RC-T.
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| 6. |
- Ekdahl, Linnea, et al.
(författare)
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Long term oncologic and reproductive outcomes after robot-assisted radical trachelectomy for early-stage cervical cancer. An international multicenter study
- 2022
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Ingår i: Gynecologic Oncology. - : Elsevier BV. - 0090-8258 .- 1095-6859. ; 164:3, s. 529-534
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Long term outcomes following fertility sparing robot-assisted radical trachelectomy (RRT). Methods: A retrospective study of consecutive women selected for RRT between 2007 and 2019 at five referral centres. Generally used selection criteria for fertility-sparing surgery were applied. Oncologic, reproductive and long-term clinical data were analysed. Results: Of the 166 included women, 149 completed a RRT. Median tumor size was 9 mm (range 3-20 mm), 111 women (75%) had FIGO 2009 stage IB1 cancer and 4.8% were node positive. At a median follow up of 58 months, 12 of all women (7.2%) and 9 of 149 women (6%) who underwent completed RRT with fertility preservation had recurred and two had died. 70 of 88 women (80%) who attempted to conceive succeeded, resulting in 81 pregnancies that progressed beyond the first trimester and 76 live births of which 54 (70%) were delivered at term and 65 (86%) delivered after gestational week 32. A short postoperative cervical length was associated with impaired fertility. A late secondary hysterectomy was necessary in four women due to persistent bleeding (n = 2), hematometra due to a cervical stenosis (n = 1) and recurrent dysplasia (n = 1). Conclusion: In this long-term follow-up of RRT the recurrence rate is comparable to larger individual studies of minimally invasive or vaginal radical trachelectomy with similar risk profile and follow up. The high pregnancy rate and low rate of premature delivery before 32 weeks GA may promote the use of robot-assisted approach.
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| 7. |
- Falconer, Henrik
(författare)
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Endometriosis and ovarian reserve : inflammation and prognostic markers
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Endometriosis is a common, benign gynecological disease, associated with pelvic pain and infertility. It is generally thought to be caused by retrograde shedding of menstrual tissue with subsequent attachment to peritoneal surfaces. Endometriosis involves an altered inflammatory response and TNF seems to be an important pro-inflammatory mediator. Current medical treatment implies hormonal suppression associated with several side-effects. During treatment, pregnancy is either impossible or contra-indicated. Infertile women with endometriosis may conceive after assisted reproduction. However, during IVF, women with endometriosis often show a poor response to ovarian hyperstimulation and have lower pregnancy rate. This suggests that women with endometriosis have reduced ovarian reserve. Identifying diminished ovarian reserve is important during infertility treatment. Several factors have been proposed as markers of ovarian reserve. Aims: To study the effects of a TNF-inhibitor on induced endometriosis and pregnancy outcome in an experimental animal model; to evaluate the significance of two markers for ovarian reserve, FSH-receptor polymorphisms and AMH, in relation to infertility, endometriosis and inflammation. Material and methods: Endometriosis was induced in 18 female baboons and the extent of disease was measured during laparoscopy. The animals were randomized to either TNF-inhibitor (c5N, n=11) or placebo (n=7) for 25 days. The effects were evaluated by laparoscopy. 16 of the baboons received an additional 3 infusions of c5N (n=9) or placebo (n=7). Subsequently, timed mating was commenced. Pregnancy outcome was evaluated after 9 cycles. Single nucleotide polymorphisms (SNPs) at pos 680 (exon 10) in the FSH-receptor was analysed in 68 infertile women using PCR and DNA sequencing. 15 of these women had FSH-levels >10 IU/ml on cycle day 3 or after clomiphene challenge test (CCCT). AMH was measured in serum and follicular fluid from 72 women with endometriosis (n=34) and tubal factor infertility (n=38). In addition, several cytokines and growth factors were analysed in follicular fluid during IVF. Results: Total surface area and volume of endometriotic lesions was significantly reduced in animals treated with c5N compared to placebo. The strongest effect was recorded for red lesions. No adverse effects were observed on the menstrual cycle in either group. Pregnancy rates and cycle fecundity rate (CFR) were comparable in both groups after timed mating. Women with FSH-receptor variant Serine/Serine at pos 680 had significantly higher FSH after CCCT but no differences in receptor distribution were observed. Women with endometriosis had lower AMH in serum and higher amounts of TNF in follicular fluid than women with tubal factor infertility. Women with endometriosis produced fewer small follicles and had a lower fertilization rate after IVF. Conclusion: The results support a central role for TNF in endometriosis. Women with endometriosis seemingly have a diminished ovarian reserve, related to increased inflammatory activity. Inhibition of TNF could represent a novel principle for the treatment of this common disease. Serum levels of AMH may aid the clinician to identify poor responders among women with endometriosis prior to IVF treatment. Also, certain FSH-receptor variants may be a characteristic for a subset of infertile women.
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| 8. |
- Falconer, Henrik, et al.
(författare)
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Robot-assisted approach to cervical cancer (RACC) : an international multi-center, open-label randomized controlled trial
- 2019
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Ingår i: International Journal of Gynecological Cancer. - : BMJ Publishing Group Ltd. - 1048-891X .- 1525-1438. ; 29:6, s. 1072-1076
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Tidskriftsartikel (refereegranskat)abstract
- Background: Radical hysterectomy with pelvic lymphadenectomy represents the standard treatment for early-stage cervical cancer. Results from a recent randomized controlled trial demonstrate that minimally invasive surgery is inferior to laparotomy with regards to disease-free and overall survival.Primary Objective: To investigate the oncologic safety of robot-assisted surgery for early-stage cervical cancer as compared with standard laparotomy.Study Hypothesis: Robot-assisted laparoscopic radical hysterectomy is non-inferior to laparotomy in regards to recurrence-free survival with the advantage of fewer post-operative complications and superior patient-reported outcomes.Trial Design: Prospective, multi-institutional, international, open-label randomized clinical trial. Consecutive women with early-stage cervical cancer will be assessed for eligibility and subsequently randomized 1:1 to either robot-assisted laparoscopic surgery or laparotomy. Institutional review board approval will be required from all participating institutions. The trial is coordinated from Karolinska University Hospital, Sweden.Major Inclusion/Exclusion Criteria: Women over 18 with cervical cancer FIGO (2018) stages IB1, IB2, and IIA1 squamous, adenocarcinoma, or adenosquamous will be included. Women are not eligible if they have evidence of metastatic disease, serious co-morbidity, or a secondary invasive neoplasm in the past 5 years.Primary Endpoint: Recurrence-free survival at 5 years between women who underwent robot-assisted laparoscopic surgery versus laparotomy for early-stage cervical cancer.Sample Size: The clinical non-inferiority margin in this study is defined as a 5-year recurrence-free survival not worsened by >7.5%. With an expected recurrence-free survival of 85%, the study needs to observe 127 events with a one-sided level of significance (alpha) of 5% and a power (1-beta) of 80%. With 5 years of recruitment and 3 years of follow-up, the necessary number of events will be reached if the study can recruit a total of 768 patients.Estimated Dates for Completing Accrual and Presenting Results: Trial launch is estimated to be May 2019 and the trial is estimated to close in May 2027 with presentation of data shortly thereafter.
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| 9. |
- Johansen, Gry, et al.
(författare)
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Reproductive and oncologic outcome following robot-assisted laparoscopic radical trachelectomy for early stage cervical cancer.
- 2016
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Ingår i: Gynecologic Oncology. - : Elsevier BV. - 1095-6859 .- 0090-8258.
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate the reproductive and oncologic outcome following robotic radical trachelectomy for early stage cervical cancer. Methods All women with early stage cervical cancer planned for fertility-sparing robotic trachelectomy between December 2007 and April 2015 at two tertiary referral centers in Sweden were identified. Perioperative- and follow-up data was retrieved from prospective databases used for all robotic procedures at the respective institution and an additional review of computerized patient files was performed. Reproductive outcome evaluation was restricted to women with ≥ 12 months follow-up and an active wish to conceive. Oncological outcome was evaluated for all patients. Results Fifty-six women (3 stage IA1, 14 stage IA2 and 39 stage IB1) were included. The median age was 29 years (range 23-41). Median follow-up was 24 months (range 1-89). Seven trachelectomies were aborted in favor of a radical hysterectomy and/or chemoradiation due to nodal metastases or insufficient margins; two distant recurrences occurred in these women. A local recurrence was seen in two of the 49 women (4%) in whom the procedure was completed as planned. Seventeen of the 21 women (81%) in the reproductive follow-up group conceived - 16 naturally and one following IVF. Sixteen women (94%) delivered in the third trimester, 12 women (71%) in gestational week ≥ 36. One (6%) second trimester delivery occurred. Conclusion The high fertility rate, low rate of premature deliveries and an acceptable rate of recurrence support the feasibility of robotic fertility-sparing radical trachelectomy in women with early stage cervical cancer.
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| 10. |
- Lueck, Jenna, et al.
(författare)
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Persistent organic pollutants in the Atlantic and southern oceans and oceanic atmosphere
- 2017
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Ingår i: Science of the Total Environment. - : Elsevier BV. - 0048-9697 .- 1879-1026. ; 583, s. 64-71
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Tidskriftsartikel (refereegranskat)abstract
- Persistent organic pollutants (POPs) continue to cycle through the atmosphere and hydrosphere despite banned or severely restricted usages. Global scale analyses of POPs are challenging, but knowledge of the current distribution of these compounds is needed to understand the movement and long-term consequences of their global use. In the current study, air and seawater samples were collected Oct. 2007- Jan. 2008 aboard the Icebreaker Oden en route from Göteborg, Sweden to McMurdo Station, Antarctica. Both air and surface seawater samples consistently contained α-hexachlorocyclohexane (α-HCH), γ-HCH, hexachlorobenzene (HCB), α-Endosulfan, and polychlorinated biphenyls (PCBs). Sample concentrations for most POPs in air were higher in the northern hemisphere with the exception of HCB, which had high gas phase concentrations in the northern and southern latitudes and low concentrations near the equator. South Atlantic and Southern Ocean seawater has a high ratio of α-HCH to γ-HCH, indicating persisting levels from technical grade sources. The Atlantic and Southern Ocean continue to be net sinks for atmospheric α-, γ-HCH, and Endosulfan despite declining usage.
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