Current opinion in obstetrics & gynecology
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Curr. Opin. Obstet. Gynecol. · Feb 2008
ReviewUpdate on lymphadenectomy in early and advanced ovarian cancer.
Pelvic and para-aortic lymphnode sampling is an integral part of the staging system of ovarian cancer. The issue concerning lymphadenectomy in the management of the disease is still debated, however. The purpose of this paper is to review the role of systematic lymphadenectomy in patients affected by early and advanced-stage ovarian cancer. ⋯ Systematic lymphadenectomy has a diagnostic value in early-stage ovarian cancer, thanks to the possibility of accurate clinical staging. As up to 22% of women, who were presumed to have early-stage ovarian cancers, are upstaged during the lymphadenectomy procedure, accurate staging can help to avoid unnecessary postoperative chemotherapy. In patients affected by advanced ovarian cancer, systematic lymphadenectomy statistically significantly improves progression-free survival and reduces recurrence rates despite a higher incidence of postoperative complications. As improvement of overall survival is not statistically significant, further studies are needed to balance risks and benefits of systematic lymphadenectomy in advanced-stage disease.
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Curr. Opin. Obstet. Gynecol. · Feb 2008
ReviewDiscovery and application of protein biomarkers for ovarian cancer.
To review the protein biomarker research field in ovarian cancer, including the discovered new biomarkers, biomarker panels, their potential clinical applications, and suggested strategies for biomarker discovery and development. ⋯ The present review summarizes the main advances in the past year, with the lists of biomarkers/panels, their potential applications, and new strategies/lessons we learned based on the most important work published during this period.
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The present article is an update on the effects of drug abuse on pregnancy outcome. ⋯ Substance abuse in pregnancy is associated with significant maternal and fetal morbidity. Risk factors suggesting substance abuse in pregnancy include lack of prenatal care, history of premature labor, and cigarette smoking. In the United States the American College of Obstetricians and Gynecologists has made multiple recommendations regarding management of parturients with drug abuse during pregnancy. Women who acknowledge use of illicit substance during pregnancy should be counseled and offered necessary treatment. The American College of Obstetricians and Gynecologists also acknowledged that some states consider intrauterine fetal drug exposure to be a form of child neglect or abuse under the law.
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To discuss the recent experience and feasibility of integrating robot-assisted technology into minimally invasive gynecologic surgery. Current applications in gynecology and their associated outcomes will be analyzed. ⋯ Current evidence demonstrates the safety and feasibility of the robotic approach for gynecologic surgery. Experience is still in its infancy, however, and prospective trials are needed to compare the efficacy against conventional laparoscopy and to help determine not only who should be doing robotic-assisted surgery but also for which applications.
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Curr. Opin. Obstet. Gynecol. · Jun 2007
ReviewThe impact of cesarean birth on subsequent fertility.
Recently, the rate of cesarean delivery has increased to 25-30% of all births, the highest rate ever reported in the USA. Primary cesarean deliveries, especially elective procedures, mainly contribute to this increase. Currently, controversy concerning elective cesarean delivery is an area of growing debate. Women should be well informed about the benefits and risks of on-demand cesarean delivery. This may be problematic, however, due to the limited current scientific data on the benefits and risks. One of the issues causing debate is the association between cesarean section and subsequent infertility. In the present review, we aim to analyze the evidence for the impact of cesarean delivery on subsequent fertility. ⋯ Elective cesarean section does not appear to cause infertility. What we need now, however, are more qualitative studies to determine the contribution of cesarean section per se on fecundity.