The incidence of vaginal intraepithelial neoplasia (VaIN) is estimated at 0.2 to 0.3 cases per 100 000 women, consisting 1% of all intraepithelial neoplasia of the lower genital tract. 1-3 Studies have shown that VaIN constitutes a precursor lesion which may progress to vaginal carcinoma. 4,5 Potential risk factors for the development of VaIN involve promiscuity, early initiation of sexual intercourse, tobacco consumption and human papillomavirus (HPV) infection. Moreover, women with a history of cervical neoplasia or suffering from condylomata acuminata, are at increased risk of developing VaIN lesions compared with the general population. 6,7
The aim of this review is to investigate and compare all laparoscopic techniques that can be used in the surgical repair of advanced uterine prolapse. A systematic search of the PubMed, Scopus, Cochrane CENTRAL, and Clinicaltrials.gov databases was performed for articles published up to December 2020, reporting data on the treatment of severe uterine prolapse using laparoscopic procedures. Only studies in the English language, with a patient sample of ≥20 and a follow-up time of ≥12 months were included. The final synthesis of this review consisted of six studies. The main laparoscopic procedures reported were vaginally assisted laparoscopic sacrocolpopexy, vaginally assisted laparoscopic uterine sacropexy, laparoscopic sacrocolpopexy with laparoscopic supracervical hysterectomy, laparoscopic inguinal ligament suspension with uterine preservation, and laparoscopic uterosacral ligament suspension combined with trachelectomy. All procedures involved mesh placement, except for laparoscopic uterosacral ligament suspension. All procedures reported anatomical cure rates > 90%. Vaginally assisted laparoscopic sacrocolpopexy had the largest amount of intraoperative blood loss whilst vaginally assisted laparoscopic uterine sacropexy was associated with bladder injuries intraoperatively. All vaginally assisted procedures reported cases of mesh extrusion postoperatively. Laparoscopic inguinal ligament suspension was the operation with the longest mean operative and hospitalization time. Conversions were not reported. The present study shows that minimally invasive surgery can be used efficiently as an alternative to open surgery in the treatment of severe uterine prolapse.
Gestational diabetes mellitus (GDM) typically occurs when maternal glucose metabolism fails to compensate for the gradually increasing insulin resistance which mainly derives from the indigenous production of diabetogenic placental hormones during pregnancy. With its rising prevalence nowadays, GDM constitutes one of the most serious health problems in pregnant women that may result in both maternal and neonatal adverse outcomes if not treated properly. Although most women succeed in controlling their blood glucose levels with diet alone, some require pharmacological treatment in order to achieve adequate glycemic control. For these women, insulin is considered to be the best pharmacological choice for their treatment. However, a growing number of recent studies suggest oral antidiabetic agents to be equivalent if not superior to insulin in terms of safety and efficacy for the treatment of GDM. The objective of this review is to evaluate efficacy and safety of metformin in the treatment of GDM based on the most recent data of the literature.
surgical approach. To account for these differences, inverse probability weighting was performed to consider both groups fully comparable.We used inverse probability weighting to define two comparable groups (sentinel node biopsy vs lymphadenectomy). We performed a logistic regression to calculate the odds of having positive nodes after a sentinel node biopsy compared with a lymphadenectomy in the weighted sample. We also compared the disease-free survival and the overall survival between groups in the weighted cohort. Result(s)* We found that women who underwent a sentinel node biopsy had smaller tumours and were more using minimally invasive surgery . In the weighted cohort we found that women who underwent a sentinel node biopsy had a 15.7% of positive nodes vs. 10-7 % in the lymphadenectomy arm. Sentinel node patients had 1.63-fold higher odds (95% CI: 1.00-2.64) of having a diagnosis of positive nodes. We did not find that undergoing a sentinel node biopsy had any association neither with disease free survival nor with overall survival. Conclusion* After applying an Inverse Probability Weighting using a propensity score, the use of Sentinel Lymph Node Biopsy increased the detection of positive nodes by 63% in the SUCCOR study . The standard pelvic lymphadenectomy might underdiagnose the nodal status in early cervical cancer.
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