| 21. |
- Kannisto, Päivi, et al.
(författare)
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Outcomes Following Exenteration for Gynecological Neoplasms
- 2021
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Ingår i: Surgical Management of Advanced Pelvic Cancer. - : Wiley. - 9781119518495 - 9781119518402 ; , s. 265-282
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Bokkapitel (refereegranskat)abstract
- The primary treatment of gynecological malignancies has considerably evolved over the last century, with a move to less aggressive procedures when appropriate. However, gynecological malignancies comprise a heterogeneous group, with varying treatment options. The choice of reconstructive method for urinary and fecal diversion is crucial, as most patients have been irradiated with high doses or had prior surgery for their primary neoplasm. Patient characteristics, such as age and comorbidity, also affect the choice of urinary diversion, especially when opting for a continent reconstruction in the setting of an anterior exenteration for a gynecological cancer. For patients with advanced gynecological tumors requiring both urinary and fecal diversion, that is, two stomas, a double-barreled colostomy has been popularized. The optimal localization of the urinary stoma is an integral part of the preoperative preparation and of critical importance to avoid postoperative difficulties with stoma accessories or emptying a continent cutaneous diversion.
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| 22. |
- Kannisto, Päivi, et al.
(författare)
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Prejunctional alpha 2-adrenoreceptors modulate the stimulated release of noradrenaline in isolated follicle strips from bovine ovaries
- 1989
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Ingår i: Journal of Autonomic Pharmacology. - : Wiley. - 0144-1795 .- 1365-2680. ; 9:6, s. 411-417
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Tidskriftsartikel (refereegranskat)abstract
- 1. Strips from the follicle wall of bovine ovaries were incubated in Krebs-Ringer solution containing 3H-noradrenaline for measurement of transmitter liberation during electrical field stimulation (5 Hz frequency, 1 ms pulse duration, 10 V between the electrodes). The effects of noradrenaline as well as selective alpha-adrenoreceptor agonists and antagonists were studied on the electrically induced efflux of radioactivity. 2. Noradrenaline (1 microM) inhibited the stimulated release of radioactivity. The alpha 2-adrenoreceptor agonist, oxymetazoline, significantly reduced the release of radioactivity in concentrations as low as 0.01 microM. The alpha 1-adrenoreceptor agonist, phenylephrine (0.01-1 microM), was without significant effect. 3. Phentolamine (0.01-1 microM) and the selective alpha 2-adrenoreceptor antagonist, idazoxan (0.01-1 microM) significantly enhanced the electrically evoked release. The alpha 1-adrenoreceptor antagonist, prazosin (0.01-1 microM), was without effect. Idazoxan (0.1 microM) reversed the inhibitory effect of oxymetazoline (0.1 microM). 4. It is concluded that administration of noradrenaline or the alpha 2-adrenoreceptor agonists reduces the release of labelled noradrenaline by acting on prejunctional alpha 2-adrenoreceptors in the noradrenergic nerves distributed in the wall of the bovine ovarian follicle. This is one of several prejunctional receptor mechanisms that modulate the activity of the sympathetic nerves innervating the smooth musculature of the follicle wall.
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| 23. |
- Liedberg, Fredrik, et al.
(författare)
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Effects of vasoactive intestinal polypeptide (VIP) on the neuromuscular complex in the bovine ovarian follicle wall
- 1993
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Ingår i: Journal of Autonomic Pharmacology. - : Wiley. - 0144-1795 .- 1365-2680. ; 13:3, s. 201-209
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Tidskriftsartikel (refereegranskat)abstract
- 1. When stimulating the local nerves in the bovine ovarian follicle wall preparation (4 Hz, 1 ms pulse duration and 7.5 V between the electrodes) vasoactive intestinal polypeptide reduced the neurogenic contraction and at the highest concentration tested (3 x 10(-7) M) almost abolished the response. Peptide histidine isoleucine only slightly reduced the contraction. 2. Strips from the follicle wall of bovine ovaries were incubated in Krebs-Ringer solution containing [3H]-noradrenaline for measurement of transmitter liberation during electrical field stimulation (5 Hz frequency, 1 ms pulse duration, 10 V between the electrodes). Vasoactive intestinal polypeptide had no effect on the electrically induced efflux of radioactivity. 3. Vasoactive intestinal polypeptide and its related peptide, peptide histidine isoleucine, relaxed precontracted follicle strips dose dependently with I(max) at 3 x 10(-7) M of 60% and 40% respectively. 4. Vasoactive intestinal polypeptide 10(-7) M did not alter the EC50 value of the noradrenaline-(10(-9)-10(-4) M) or carbachol-induced (10(-8)-3 x 10(-4) M) contraction in the follicle strips, but significantly reduced the E(max) value of the noradrenaline but not the carbochol-mediated contraction. 5. These results suggests that vasoactive intestinal polypeptide, and to some extent peptide histidine isoleucine, have a postjunctional role in ovarian follicle contractility and might further interfere with the ovulatory process.
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| 24. |
- Liedberg, Fredrik, et al.
(författare)
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Should we Refrain from Performing Oophorectomy in Conjunction with Radical Cystectomy for Bladder Cancer?
- 2017
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Ingår i: European Urology. - : Elsevier BV. - 0302-2838. ; 71:6, s. 851-853
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Tidskriftsartikel (refereegranskat)abstract
- Radical cystectomy with neoadjuvant chemotherapy is the gold standard for treating muscle-invasive bladder cancer. Women subjected to radical cystectomy are frequently postmenopausal, and the median age for bladder cancer diagnosis in women in Sweden is currently 73 yr (Swedish National Bladder Cancer Register). Traditionally, most women treated with radical cystectomy have undergone simultaneous bilateral oophorectomy and hysterosalpingectomy to diminish the risk of later ovarian disease and ovarian bladder cancer recurrence, but also the belief that there is no impact on health or health-related quality of life associated with oophorectomy and the fact that it might be easier surgery to take the ovarian pedicles, rather than sparing the ovaries. However, pelvic organ preservation is considered in some younger women to diminish postoperative functional impairment. Based on recent literature in several areas related to oophorectomy, we question the rationale and arguments for performing oophorectomy in women in conjunction with radical cystectomy for bladder cancer. It can be questioned whether routine bilateral oophorectomy during radical cystectomy is advisable in premenopausal women, and the same might also apply to selected postmenopausal women.
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| 25. |
- Martin de la Fuente, Laura, et al.
(författare)
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Copy number signatures for early diagnosis of high-grade serous ovarian carcinoma
- 2022
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundThe detection of ovarian carcinoma-derived somatic mutations in cervical samples and uterine lavages in several studies since 2013, has brought hope for the development of new biomarkers for early detection. High-grade serous ovarian carcinoma (HGSC) is strongly dominated by copy number alterations (CNAs). These CNAs are the consequence of underlying mutational processes in HGSC. We interrogated CNAs from low coverage whole-genome sequencing (WGS) data in HGSC tumors, plasma, endometrial biopsies, and cervical samples to explore if copy number signatures can be used as a biomarker for early detection of HGSC.Methods A total of 204 samples were included from 18 patients with HGSC, four BRCA mutation carriers and seven benign controls. Estimations of ploidy and cellularity, and thus calculation of absolute copy number, were optimized through a combination of the ACE, Rascal, and ichorCNA bioinformatic tools. Mixture modelling was used to subgroup the six fundamental copy number features and non-negative matrix factorization was used to generate the signatures and cluster the samples.ResultsWe extracted six fundamental copy number features from 69 diagnostic and pre-diagnostic cervical samples from patients diagnosed with HGSC and generated six CN signatures. We found different distributions of features in benign samples compared to tumors and cervical samples from HGSC patients. We also observed different exposures to the six signatures in different patient groups.ConclusionsFurther understanding of the components and cell types contributing to each signature, and inclusion of more cervical samples into the approach, will hopefully identify a novel tumorigenic signature for early detection of HGSC in cervical samples.
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| 26. |
- Martin de la Fuente, Laura, et al.
(författare)
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PD-1/PD-L1 expression and tumor-infiltrating lymphocytes are prognostically favorable in advanced high-grade serous ovarian carcinoma
- 2020
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Ingår i: Virchows Archiv: an international journal of pathology. - : Springer Science and Business Media LLC. - 1432-2307. ; 477:1, s. 83-91
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Tidskriftsartikel (refereegranskat)abstract
- The response rate to checkpoint inhibitors for women with high-grade serous carcinoma of the ovary, fallopian tube, and peritoneum (HGSC) is modest, and development of predictive biomarkers is needed. The main focus has been on tumor cell PD-L1 expression, but its assessment alone is insufficient for patient selection in most malignancies. We mapped the presence of macrophages (CD68 and CD163) and lymphocytes (CD3) located within the tumor epithelium, the cell type-specific expression of PD-L1 and PD-1, and their impact on 5-year overall survival (OS) in a consecutive cohort of 130 women diagnosed with advanced HGSC between 2011 and 2015. PD-L1 was expressed mainly by macrophages (not by tumor cells) and PD-1 by lymphocytes. Women with higher CD3, PD-L1, and PD-1 expression had improved OS (P = 0.03, P = 0.007, and P = 0.02, respectively). In the external data set (203 women), high expression of CD274 (encoding PD-L1) was associated with improved OS (P = 0.03), in accordance with our results. Furthermore, higher CD163 expression was associated with better outcome in women with no residual tumor after primary surgery (P = 0.02). Thus, women with greater lymphocyte tumor infiltration had better outcome and PD-L1/PD-1 expression, regardless of PD-1/PD-L1 being markers for immune suppressive pathways, conferred a survival benefit in our cohort. Our results highlight that tumor immunity may be harnessed in subsets of HGSC.
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| 27. |
- Nilsson, Christer, et al.
(författare)
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The neuropeptides vasoactive intestinal polypeptide, peptide histidine isoleucine and neuropeptide Y modulate [3H]noradrenaline release from sympathetic nerves in the choroid plexus
- 1990
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Ingår i: European Journal of Pharmacology. - 1879-0712. ; 181:3, s. 247-252
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Tidskriftsartikel (refereegranskat)abstract
- The neurotransmitter peptides vasoactive intestinal polypeptide (VIP), peptide histidine isoleucine (PHI) and neuropeptide Y (NPY) are located in nerve fibers supplying the pig choroid plexus, which receives an abundant sympathetic innervation. We characterized the release of [3H]noradrenaline ([3H]NA) from this tissue elicited by electrical field stimulation and studied the effects of the above-mentioned peptides on this release. The release of [3H]NA was found to be almost exclusively of neurogenic origin, despite there being a marked non-neuronal uptake of [3H]NA into the epithelium of the choroid plexus. NPY significantly decreased the release of [3H]NA by approximately 10% while VIP and PHI enhanced release by up to 25 and 35%, respectively, indicating a possible synergistic role of the two latter peptides and NA in the choroid plexus.
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| 28. |
- Norbeck, Anna, et al.
(författare)
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Age and Referral Route Impact the Access to Diagnosis for Women with Advanced Ovarian Cancer
- 2023
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Ingår i: Journal of Multidisciplinary Healthcare. - 1178-2390. ; 16, s. 1239-1248
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The majority of women with ovarian cancer are diagnosed in late stages. Most women do have symptoms prior to diagnosis, sometimes several months before the diagnosis. The aim of this study was to evaluate the timeline from the first presentation of symptoms to a physician until there is a reasonable suspicion of cancer, among women diagnosed with advanced stage ovarian cancer. We wanted to investigate which symptoms were the most common and whether there are other factors affecting the time interval before the suspicion of cancer was confirmed.Patients and Methods: This was a retrospective population-based cohort study of women diagnosed with advanced ovarian cancer between January 1, 2017 and December 31, 2019 who were referred to Skane University Hospital Lund, Sweden. Data were collected from electronic medical records at Skane University Hospital. The time interval was recorded as the time from first physician consultation with predefined symptoms to the date when there was a reasonable suspicion of ovarian cancer. Data processing and statistical analysis were performed with the statistical software R.Results: Among the 249 patients included in this study, the median time interval from the first consultation to the reasonable suspicion of cancer was 24 days. The first consultation in specialized care had a 70% decrease in delay compared to primary care. Emergency consultations had a 52.2% decrease in time delay compared to planned consultations. Older age was associated with an increase in the geometric mean by 54.7%, comparing the first to the third quartile. The most common symptom was abdominal pain.Conclusion: The length of time interval from first presentation with symptoms relating to ovarian cancer to reasonable suspicion of cancer was associated with whether the consultation was in primary or specialized care, emergency or planned visit and the patient’s age.
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| 29. |
- Persson, Jan, et al.
(författare)
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Robot-assisted abdominal laparoscopic radical trachelectomy.
- 2008
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Ingår i: Gynecologic Oncology. - : Elsevier BV. - 1095-6859 .- 0090-8258. ; 111, s. 564-567
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Radical trachelectomy in conjunction with pelvic lymphadenectomy is an established method to preserve fertility in early cases of cervical cancer. The radical trachelectomy is usually performed vaginally despite the initial use of laparoscopy for the lymphadenectomy. The complexity of a laparoscopic abdominal trachelectomy may explain this dual approach. Here we describe the surgical technique of a robot-assisted laparoscopic radical trachelectomy with lymphatic mapping using a radiotracer and without a vaginal approach. CASES AND SURGICAL TECHNIQUE: Two nulliparous women with early cervical cancer underwent a laparoscopic radical trachelectomy and pelvic lymphadenectomy with the assistance of the da Vinci robot (Intuitive Surgical Inc, Sunnyvale, CA). After the sentinel lymph nodes were found negative on frozen section, the parametria, paracolpia and sacrouterine ligaments were dissected sparing the main branches of the uterine arteries. Following ligation of the descending branches of the uterine arteries the cervix and the vagina were transsected using monopolar diathermia and the vagina was sutured to the remaining cervix. Finally, a permanent cerclage was placed. Time for surgery was 387 and 358 min respectively. No perioperative complications were noted and the postoperative period was uneventful in both cases. CONCLUSIONS: Robot-assisted laparoscopic abdominal trachelectomy is a feasible alternative to a combined laparoscopic and vaginal approach.
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| 30. |
- Persson, Jan, et al.
(författare)
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Robot assisted laparoscopic radical hysterectomy and pelvic lymphadenectomy with short and long term morbidity data.
- 2009
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Ingår i: Gynecologic Oncology. - : Elsevier BV. - 1095-6859 .- 0090-8258. ; 113, s. 185-190
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate feasibility and morbidity of robot assisted laparoscopic radical hysterectomy. METHODS: From December 2005 to September 2008 robot assisted laparoscopic radical hysterectomy and pelvic lymphadenectomy was performed on 80 women. Using a prospective protocol, and an active investigation policy for defined adverse events, perioperative, short and long term data were obtained. RESULTS: Time for surgery (skin to skin) reached 176 and 132 min after 9 and 34 procedures respectively. All tumours were radically removed. Median number of retrieved lymph nodes was 26 (range 15-55). All women had an early follow up (1-3 months) and 43 of eligible 46 women (93%) had a long term follow up (>/=12 months). In 33 of 80 women (41%) the peri/postoperative period was uneventful. The remainder had one or more mainly mild adverse events, most commonly from the vaginal cuff (n=17, 21%) or the lymphatic system (n=16, 20%). The proportion of uneventful cases increased significantly over time. Five women were resutured for dehiscence of the vaginal cuff, two women were reoperated for trocar site hernias and one woman had a ureter stricture that resolved following stent treatment. Eight women (14%) needed 60 days or more to resume spontaneous voiding. One 72-year old woman with disseminated endometrial cancer on autopsy died of pulmonary embolism 31 days after surgery. CONCLUSIONS: Robot assisted laparoscopic radical hysterectomy is a feasible alternative to conventional laparoscopy and open surgery. Effort should be made to ensure proper closure of the vaginal cuff, trocar sites and to develop nerve sparing techniques.
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