The perceptions of gynecologic oncology fellows on readiness for subspecialty training following OB/GYNRESIDENCY
The objective of this study was to evaluate the perceptions of current and former fellows in gynecologic oncology of their readiness for fellowship training. A previously used survey was modified and distributed in 2016 to current and former fellows in GO. The survey explored domains of independent practice, psychomotor ability, clinical evaluation and scholarship. A standard Likert scale was employed and domains/responses were tailored to the subspecialty. A total of 150 current and recently former fellows responded to the survey, for a response rate of 38.7%. Nearly 70% of respondents reported being able to independently perform a hysterectomy when starting fellowship, and nearly 50% felt they could perform lysis of adhesions either without assistance. Although nearly 95% reported having had the opportunity to develop a plan of action for patients on labor and delivery, only 40.7% felt able to independently manage postoperative complications without assistance. Common themes that emerged in the open-ended responses pertained to self-perception of inadequate surgical skills and knowledge specific to gynecologic oncology. Although the majority of current and former fellows in gynecologic oncology report feeling prepared for fellowship, themes noted in the open-ended responses suggest a lack of confidence in surgical skills and clinical knowledge.
AbstractIntroduction and hypothesisOur aim was to evaluate the clinical outcome of continent women with high-risk predictors for de novo stress urinary incontinence (SUI) offered prophylactic midurethral sling (MUS) insertion during vaginal pelvic reconstructive surgery (PRS) for advanced pelvic organ prolapse (POP).Materials and methodsThis was a prospective cohort study in patients with POP stage ≥ 3 and maximum urethral closure pressure (MUCP)
ConclusionsThis large series suggests that laparoscopic sacrocolpopexy might confer a low risk of mesh exposure. Together with good anatomical and patient-reported outcomes, laparoscopic sacrocolpopexy is a safe option for patients presenting with post-hysterectomy vault prolapse.
Publication date: Available online 21 August 2019Source: Case Reports in Women's HealthAuthor(s): Glaiza S. de Guzman, Eileen M. ManaloAbstractUterine leiomyomas are tumor-associated causes of secondary erythrocytosis. Ectopic erythropoietin production by fibroid smooth muscles has been proposed and demonstrated in the literature. Here, we present three cases of large leiomyomas with an incidental finding of isolated erythrocytosis on preoperative workup. Two patients underwent total abdominal hysterectomy while one patient underwent a myomectomy. Both histologic examination confirming the diagnosis of leiomyoma and serial...
CONCLUSIONS: We were able to define predictors of admission for patients having LH/RAH managed with an ERAS pathway. Increased ASA physical status, being African American, and increased length of procedure were significantly associated with admission after LH/RAH performed under an ERAS pathway. In addition, the incidences of urgent clinic and ER visits, readmissions, and reoperations within 90 days of surgery were similar for patients who were discharged on the day of surgery compared to those admitted. PMID: 31425219 [PubMed - in process]
Authors: Sichitiu J, El-Tani Z, Mathevet P, Desseauve D Abstract In the last 30 years, with increasing cesarean section rates, the incidence of the placenta accreta spectrum has also increased. It is estimated that by the year 2020 there will be nearly 9000 cases annually in the United States. Currently, no consensus exists regarding optimal management. Conventional treatment by cesarean-hysterectomy is challenging, with a high maternal morbidity due to massive hemorrhage, and surgical complications such as urinary tract, bowel and pelvic nerve injury, in addition to loss of fertility and its accompanying psyc...
A 66-year-old female was referred to dermatology for melanonychia, which was later identified as a splinter hemorrhage on examination. Incidentally, she was found to have two 4-mm asymptomatic firm smooth pink papules on the upper forehead and multiple similar lesions on the posterior neck and upper back. Further history revealed that the patient had suffered from severe uterine fibroids requiring hysterectomy at age 34. The patient ’s mother, two daughters, and maternal aunt also had severe uterine fibroids requiring hysterectomy, and her mother, daughter, and maternal cousin had similar skin lesions.
A 63-year-old woman presented to the hospital with a nontender, rapidly enlarging sacral ulcer. The patient reported she felt the wound while she was in the shower and was extremely alarmed by the size. She denied any preceding injury or medical or cosmetic procedures in the area. Her past medical history was significant for endometrial carcinoma, status post bilateral salpingo-oophrectomy, hysterectomy and pelvic radiation. She also reported a sacral fracture one year prior secondary to a fall.
Condition: Uterine Neoplasms Intervention: Procedure: ERAS protocol Sponsors: Ospedale Regina Montis Regalis; Martini Hospital, Turin, Italy; Azienda Ospedaliera Città della Salute e della Scienza di Torino; Ministry of Health, Italy; Regione Piemonte Not yet recruiting
Conclusion: The accuracy of preoperative histologic examination was moderate. Our findings recommend cautious clinical decision making and limiting hysterectomy to women who do not respond to other therapeutic measures. PMID: 31423519 [PubMed - in process]
Authors: Xiao J, Zhou J, Liang L, Liu F, Liang H, Xu C, Meng J Abstract PURPOSE: To evaluate the sensitivity of apoptosis-stimulating protein of p53 (ASPP) and P-glycoprotein (P-gp) to the recombinant human adenovirus-p53 (rAd-p53) combined with neoadjuvant chemotherapy for locally advanced cervical cancer and their predictive value for efficacy. METHODS: 80 patients with histopathologically diagnosed locally advanced cervical cancer (stage Ib2-IIa2) and operative treatment from February 2009 to June 2013 were enrolled and randomly divided into 3 groups: radical hysterectomy group (RH group, n=30), simple intra...