Background:
To compare the efficacy of serotonin-norepinephrine reuptake inhibitors (SNRIs) treatment for chemotherapy-induced peripheral neuropathy (CIPN)
Methods:
Two authors independently searched MEDLINE, Embase, Cochran Library, and Web of Science to identify and review articles published from January 1998 until December 2018 according to selection criteria. Outcomes were expressed as mean difference, the pooled odds ratio, or relative risk in a meta-analysis model.
Results:
A total of 10 studies were included in this meta-analysis: 6 randomized-controlled studies and 4 observational studies. Meta-analysis showed that CIPN was improved after treatment with SNRI (standardized mean difference = 2.20; 95% confidence interval, 0.90–3.49; I
2 = 93% in 3 randomized controlled studies). Somnolence and insomnia occurred in <15% of patients. Incidence of somnolence was lower than with pregabalin treatment, and insomnia was comparable to that in expectant management or pregabalin treatment. Incidence of nausea and vomiting was higher than in expectant management, but no significant difference was found when compared to expectant management.
Conclusion:
From the several available studies suitable for indirect comparison, SNRI shows excellent efficacy and tolerability to CIPN. SNRI could provide an important treatment option for CIPN.
Objective To compare the outcomes of single port access (SPA) laparoscopic hysterectomy and conventional laparoscopic hysterectomy for the large uterus of more than 500 g. Methods Twenty-seven cases of SPA laparoscopic hysterectomy and 32 cases of conventional laparoscopic hysterectomy were retrospectively analysed. The surgery had performed by single surgeon from January 2010 to July 2011 in Chungnam National University Hospital. We compared demographic characteristics and surgical outcomes. Results There were no significant difference in patients` age, body mass index, past surgical history, postoperative additional pain control and duration of hospital stay between the two groups. Uterine weight was 706.5±363.2 g (range, 500-2,415 g) for SPA laparoscopic hysterectomy and 634.0±153.3 g (range, 500-1,130 g) for conventional laparoscopic hysterectomy and signifi cantly not different between the two groups. Operation time was signifi cantly longer in SPA laparoscopic hysterectomy than conventional laparoscopic hysterectomy (81.1±18.1 minutes vs. 67.2±16.8 minutes). Postoperative change in hemoglobin and hematocrit was statistically higher in SPA laparoscopic hysterectomy than conventional laparoscopic hysterectomy (1.9±0.9 g/dL, 2.9±4.2% vs. 1.0±1.3 g/dL, 6.2±2.9%, respectively). Conclusion Operation time was longer and postoperative change in hemoglobin and hematocrit was signifi cantly higher in SPA laparoscopic hysterectomy than conventional laparoscopic hysterectomy. However, SPA laparoscopic hysterectomy will replace conventional laparoscopic hysterectomy in a future with improving surgical technique.
To evaluate the efficacy and safety of a gonadotropin-releasing hormone (GnRH) agonist for treating large-sized submucosal leiomyoma before hysteroscopic myomectomy.The data were retrospectively collected from patients who underwent a hysteroscopic myomectomy for a submucosal leiomyoma >3.5 cm in size from January 2009 to December 2018. The patients were divided into the GnRH group and the control group according to whether they were pretreated before surgery.A total of 61 patients were included in the study, 31 in the GnRH agonist group and 30 in the control group. At diagnosis, the maximum leiomyoma diameter was similar between the 2 groups (4.67 ± 0.6 cm in the GnRH agonist group vs 3.82 ± 0.6 cm in the control group, P = .061). After pretreatment with the GnRH agonist, the maximum diameter was significantly smaller in the GnRH agonist group compared to the control group (3.82 ± 0.6 vs 4.33 ± 0.8 cm, respectively, P = .004). The leiomyoma volume in the GnRH agonist group decreased by 55.6%, from 41.68 ± 15.7 to 23.19 ± 10.4 cm 3 , which led to significant differences in leiomyoma volume between the 2 groups (23.19 ± 10.4 cm 3 in the GnRH agonist group vs 33.22 ± 24.7 cm 3 in the control group, P = .042). The GnRH agonist group showed a shorter operation time (37.7 vs 43.9 minutes, P = .040) and less uterine distention media was used (6800 vs 9373.3 mL, P = .037) compared to the control group. Postoperative complications such as estimated blood loss, remnant leiomyoma, and recurrence were similar between the 2 groups.Treatment with a GnRH agonist before hysteroscopic myomectomy for large submucosal leiomyoma might decrease the volume of the leiomyoma, reduce operation time, and the amount of uterine-distension media used without surgical complications.
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