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  • 1.
    Alder, Susanna
    et al.
    Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden.
    Megyessi, David
    Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden.
    Sundström, Karin
    Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden.
    Östensson, Ellinor
    Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden.
    Mints, Miriam
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden.
    Belkić, Karen
    Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden; School of Community and Global Health, Claremont Graduate University, California, USA; Keck School of Medicine, University of Southern California, USA.
    Arbyn, Marc
    Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium.
    Andersson, Sonia
    Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden.
    Incomplete excision of cervical intraepithelial neoplasia as a predictor of the risk of recurrent disease: a 16-year follow-up study2020Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 222, nr 2, s. 172.e1-172.e12Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Women treated for high-grade cervical intraepithelial neoplasia (CIN, grade 2 or 3) are at elevated risk of developing cervical cancer. Suggested factors identifying women at highest risk for recurrence post-therapeutically include incomplete lesion excision, lesion location, size and severity, older age, treatment modality and presence of high-risk human papilloma virus (hrHPV) after treatment. This question has been intensively investigated over decades, but there is still substantial debate as to which of these factors or combination of factors most accurately predict treatment failure.

    OBJECTIVES: In this study, we examine the long-term risk of residual/recurrent CIN2+ among women previously treated for CIN2 or 3 and how this varies according to margin status (considering also location), as well as comorbidity (conditions assumed to interact with hrHPV acquisition and/or CIN progression), post-treatment presence of hrHPV and other factors.

    STUDY DESIGN: This prospective study included 991 women with histopathologically-confirmed CIN2/3 who underwent conization in 2000-2007. Information on the primary histopathologic finding, treatment modality, comorbidity, age and hrHPV status during follow-up and residual/recurrent CIN2+ was obtained from the Swedish National Cervical Screening Registry and medical records. Cumulative incidence of residual/recurrent CIN2+ was plotted on Kaplan-Meier curves, with determinants assessed by Cox regression.

    RESULTS: During a median of 10 years and maximum of 16 years follow-up, 111 patients were diagnosed with residual/recurrent CIN2+. Women with positive/uncertain margins had a higher risk of residual/recurrent CIN2+ than women with negative margins, adjusting for potential confounders (hazard ratio (HR)=2.67; 95% confidence interval (CI): 1.81-3.93). The risk of residual/recurrent CIN2+ varied by anatomical localization of the margins (endocervical: HR=2.72; 95%CI: 1.67-4.41) and both endo- and ectocervical (HR=4.98; 95%CI: 2.85-8.71). The risk did not increase significantly when only ectocervical margins were positive/uncertain. The presence of comorbidity (autoimmune disease, human immunodeficiency viral infection, hepatitis B and/or C, malignancy, diabetes, genetic disorder and/or organ transplant) was also a significant independent predictor of residual/recurrent CIN2+. In women with positive hrHPV findings during follow-up, the HR of positive/uncertain margins for recurrent/residual CIN2+ increased significantly compared to women with hrHPV positive findings but negative margins.

    CONCLUSIONS: Patients with incompletely excised CIN2/3 are at increased risk of residual/recurrent CIN2+. Margin status combined with hrHPV results and consideration of comorbidity may increase the accuracy for predicting treatment failure.

  • 2. Baumgart, Juliane
    et al.
    Nilsson, Kerstin
    Örebro universitet, Hälsoakademin.
    Stavreus-Evers, Anneli
    Kask, Kristiina
    Villman, Kenneth
    Lindman, Henrik
    Kallak, Theodora
    Sundström-Poromaa, Inger
    Urogenital disorders in women with adjuvant endocrine therapy after early breast cancer2011Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 204, nr 1, s. 26.e1-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To investigate the prevalence of urogenital symptoms and vaginal atrophy in postmenopausal breast cancer patients on adjuvant endocrine therapy. STUDY DESIGN: A population-based, cross-sectional study on postmenopausal breast cancer patients on adjuvant endocrine treatment and age-matched control subjects. Vaginal atrophy was assessed by gynecologic examination and atrophy-related symptoms by validated questionnaires. RESULTS: In all, 57.6% of aromatase inhibitor-treated and 32.4% of tamoxifen-treated breast cancer patients rated at least 1 vaginal atrophy symptom as moderate/severe, which was significantly more common than in control subjects ( P < .01). Aromatase inhibitor-treated patients more often had moderate or severe vaginal atrophy ( P < .05), a more atrophic cytohormonal evaluation, and significantly higher vaginal pH ( P < .05) than all control subjects, irrespective of hormonal use. CONCLUSION: Our findings indicate that the frequency of vaginal atrophy symptoms, particularly in aromatase inhibitor-treated women, might have been underestimated in previous clinical trials.

  • 3.
    Idahl, Annika
    et al.
    Umeå Univ, Umeå, Sweden.
    Lundin, Eva
    Umeå Univ, Umeå, Sweden.
    Elgh, Fredrik
    Örebro universitet, Hälsoakademin. Umeå Univ, Umeå, Sweden.
    Jurstrand, Margaretha
    Örebro University Hospital, Örebro, Sweden.
    Möller, Jens K.
    Dept Clin Microbiol, Aarhus Univ Hosp, Skejby, Denmark.
    Marklund, Ingrid
    Umeå Univ, Umeå, Sweden.
    Lindgren, Peter
    Dept Womens & Childrens Hlth Obstet & Gynaecol, Uppsala Univ, Uppsala, Sweden.
    Ottander, Ulrika
    Umeå Univ, Umeå, Sweden.
    Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoeae, human papillomavirus, and polyomavirus are not detectable in human tissue with epithelial ovarian cancer, borderline tumor, or benign conditions2010Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 202, nr 1, s. 71.e1-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: We sought to analyze the presence of the microorganisms Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoeae, human papillomavirus (HPV), and the polyomaviruses BK virus (BKV) and JC virus (JCV) in ovarian tissues of women with ovarian carcinomas, borderline tumors, and benign conditions. STUDY DESIGN: Ovarian tissue, snap-frozen and stored at -80 degrees C, from 186 women with benign conditions, borderline tumors, and epithelial ovarian cancer, as well as tissue from the contralateral ovary of 126 of these women, were analyzed regarding presence of C trachomatis and N gonorrhoeae (transcription mediated amplification), M genitalium (real-time polymerase chain reaction [PCR]), HPV (PCR), and BKV and JCV (PCR). RESULTS: All the tissue samples studied were found negative for the microorganisms analyzed. CONCLUSION: C trachomatis, M genitalium, N gonorrhoeae, HPV, and the polyomaviruses BKV and JCV are not detectable in ovarian tissues either from women with benign conditions and borderline tumors or from women with ovarian cancer.

  • 4.
    Jonsson, Maria
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Ågren, Johan
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Nordén-Lindeberg, Solveig
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Ohlin, Andreas
    Region Örebro län. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Hanson, Ulf
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Neonatal encephalopathy and the association to asphyxia in labor2014Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 211, nr 6, s. 667.e1-667.e8, artikkel-id S0002-9378(14)00596-1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: In cases with moderate and severe neonatal encephalopathy, we aimed to determine the proportion that was attributable to asphyxia during labor and to investigate the association between cardiotocographic (CTG) patterns and neonatal outcome.

    STUDY DESIGN: In a study population of 71,189 births from 2 Swedish university hospitals, 80 cases of neonatal encephalopathy were identified. Cases were categorized by admission CTG patterns (normal or abnormal) and by the presence of asphyxia (cord pH, <7.00; base deficit, ≥12 mmol/L). Cases with normal admission CTG patterns and asphyxia at birth were considered to experience asphyxia related to labor. CTG patterns were assessed for the 2 hours preceding delivery.

    RESULTS: Admission CTG patterns were normal in 51 cases (64%) and abnormal in 29 cases (36%). The rate of cases attributable to asphyxia (ie, hypoxic ischemic encephalopathy) was 48 of 80 cases (60%), most of which evolved during labor (43/80 cases; 54%). Both severe neonatal encephalopathy and neonatal death were more frequent with an abnormal, rather than with a normal, admission CTG pattern (13 [45%] vs 11 [22%]; P = .03), and 6 [21%] vs 3 [6%]; P = .04), respectively. Comparison of cases with an abnormal and a normal admission CTG pattern also revealed more frequently observed decreased variability (12 [60%] and 8 [22%], respectively) and more late decelerations (8 [40%] and 1 [3%], respectively).

    CONCLUSION: Moderate and severe encephalopathy is attributable to asphyxia in 60% of cases, most of which evolve during labor. An abnormal admission CTG pattern indicates a poorer neonatal outcome and more often is associated with pathologic CTG patterns preceding delivery.

  • 5.
    Wijk, Lena
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Obstetrics and Gynecology.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Pache, Basile
    Department of Obstetrics and Gynecology, Lausanne University Hospital, Lausanne, Switzerland.
    Altman, Alon D.
    Winnipeg Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada.
    Williams, Laura L.
    Gynecologic Oncology of Middle Tennessee, HCA Centennial Hospital, Nashville, TN, USA.
    Elias, Kevin M.
    Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
    McGee, Jake
    London Health Sciences Centre, London ON, Canada.
    Wells, Tiffany
    Royal Alexandra Hospital, Edmonton AB, Canada.
    Gramlich, Leah
    Royal Alexandra Hospital, Edmonton AB, Canada.
    Holcomb, Kevin
    Clinical Obstetrics and Gynecology, Weill Cornell Medical College, New York NY, USA.
    Achtari, Chahin
    Gynecology Service, CHUV, Lausanne, Switzerland.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Dowdy, Sean C.
    Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, USA.
    Nelson, Gregg
    Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.
    International validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery2019Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 221, nr 3, s. 237.e1-237.e11Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The Enhanced Recovery After Surgery (ERAS) Society publishes guidelines on perioperative care, but these guidelines should be validated prospectively.

    OBJECTIVES: To evaluate the association between compliance to ERAS Gynecologic/Oncology guideline elements and postoperative outcomes in an international cohort.

    STUDY DESIGN: The study was comprised of 2,101 patients undergoing elective gynecologic/oncology surgery between January 2011 - November 2017 in 10 hospitals across Canada, the United States and Europe. Patient demographics, surgical/anesthesia details and ERAS protocol compliance elements (pre-, intra- and post-operative phases) were entered into the ERAS Interactive Audit System. Surgical complexity was stratified according to the Aletti scoring system (low versus medium/high). The following covariates were accounted for in the analysis: age, Body Mass Index, smoking status, presence of diabetes, American Society of Anesthesiologists class, International Federation of Gynecology and Obstetrics stage, preoperative chemotherapy, radiotherapy, operating time, surgical approach (open versus minimally invasive), intra-operative blood loss, hospital and ERAS implementation status. The primary end-points were primary hospital length of stay and complications. Negative binomial regression was used to model length of stay, and logistic regression to model complications, as a function of compliance score and covariates.

    RESULTS: Patient demographics: median age 56 years, 35.5% obese,15% smokers, 26.7% American Society of Anesthesiologists Class III-IV. Final diagnosis was malignant in 49% of patients. Laparotomy was used in 75.9% of cases, and the remainder minimally invasive surgery. The majority of cases (86%) were of low complexity (Aletti score ≤ 3). In patients with ovarian cancer, 69.5% had a medium/high complexity surgery (Aletti score 4-11). Median length of stay was 2 days in the low- and 5 days in the medium/high-complexity group. Every unit increase in ERAS guideline score was associated with 8% (IRR: 0.92 (95% CI: 0.90 - 0.95; p<0.001)) decrease in days in hospital among low-complexity, and 12% (IRR: 0.88 (95% CI: 0.82 - 0.93; p<0.001) decrease among patients with medium/high complexity scores. For every unit increase in ERAS guideline score, the odds of total complications were estimated to be 12% lower (p<0.05) among low-complexity patients.

    CONCLUSION: Audit of surgical practices demonstrates that improved compliance with ERAS Gynecologic/Oncology guidelines is associated with an improvement in clinical outcomes, including length of stay, highlighting the importance of ERAS implementation.

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