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Philip KEJ, Buttery SC, Bowen S, Lewis A, Jeffery E, Alghamdi SM, Williams P, Alasmari AM, Alsulayyim AS, Orton CM, Conway F, Chan L, Vijayakumar B, Tana A, Tonkin J, Perkins A, Garner JL, Srikanthan K, Sadaka A, Pavitt MJ, Banya W, Lound A, Elkin S, Polkey MI, Man WDC, Lewis K, Cave P, Fancourt D, Hopkinson NS. Singing for lung health in COPD: a multicentre randomised controlled trial of online delivery. BMJ Open Respir Res 2024; 11:e002365. [PMID: 38697677 PMCID: PMC11086531 DOI: 10.1136/bmjresp-2024-002365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/25/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Singing for lung health (SLH) is an arts-based breathing control and movement intervention for people with long-term respiratory conditions, intended to improve symptoms and quality of life. Online, remotely delivered programmes might improve accessibility; however, no previous studies have assessed the effectiveness of this approach. METHODS We conducted an assessor-blind randomised controlled trial comparing the impact of 12 weeks of once-weekly online SLH sessions against usual care on health-related quality of life, assessed using the RAND 36-Item Short Form Health Survey (SF-36) Mental Health Composite (MHC) and Physical Health Composite (PHC) scores. RESULTS We enrolled 115 people with stable chronic obstructive pulmonary disease (COPD), median (IQR) age 69 (62-74), 56.5% females, 80% prior pulmonary rehabilitation, Medical Research Council dyspnoea scale 4 (3-4), forced expiratory volume in 1 s % predicted 49 (35-63). 50 participants in each arm completed the study. The intervention arm experienced improvements in physical but not mental health components of RAND SF-36; PHC (regression coefficient (95% CI): 1.77 (95% CI 0.11 to 3.44); p=0.037), but not MHC (0.86 (95% CI -1.68 to 3.40); p=0.504). A prespecified responder analysis based on achieving a 10% improvement from baseline demonstrated a response rate for PHC of 32% in the SLH arm and 12.7% for usual care (p=0.024). A between-group difference in responder rate was not found in relation to the MHC (19.3% vs 25.9%; p=0.403). DISCUSSION AND CONCLUSION A 12-week online SLH programme can improve the physical component of quality of life for people with COPD, but the overall effect is relatively modest compared with the impact seen in research using face-to-face group sessions. Further work on the content, duration and dose of online interventions may be useful. TRIAL REGISTRATION NUMBER NCT04034212.
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Affiliation(s)
- Keir E J Philip
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Sara C Buttery
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Sarah Bowen
- Hywel Dda University Health Board, Carmarthen, UK
| | - Adam Lewis
- Department of Health Sciences, Brunel University London, Uxbridge, UK
| | - Edmund Jeffery
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Saeed M Alghamdi
- National Heart and Lung Institute, Imperial College London, London, UK
- Clinical Technology Department, Faculty of Applied Medical Sciences, Umm Al-Qura University College of Applied Medical Science, Makkah, Saudi Arabia
| | - Parris Williams
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Ali M Alasmari
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Respiratory Therapy, College of Medical Rehabilitation, Taibah University, Madinah, Al Madinah, Saudi Arabia
| | - Abdullah S Alsulayyim
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Christopher M Orton
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Francesca Conway
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Ley Chan
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Bavithra Vijayakumar
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Anand Tana
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - James Tonkin
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Alexis Perkins
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Justin L Garner
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Karthikan Srikanthan
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Ahmed Sadaka
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Matthew J Pavitt
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Winston Banya
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Adam Lound
- Patient Experience Research Centre, Imperial College, London, UK
| | - Sarah Elkin
- Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Michael I Polkey
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - William D-C Man
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Keir Lewis
- Hywel Dda University Health Board, Carmarthen, UK
| | - Phoene Cave
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, London, UK
| | - Nicholas S Hopkinson
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
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Shah PL, Orton CM, Grinsztejn B, Donaldson GC, Crabtree Ramírez B, Tonkin J, Santos BR, Cardoso SW, Ritchie AI, Conway F, Riberio MPD, Wiseman DJ, Tana A, Vijayakumar B, Caneja C, Leaper C, Mann B, Samson A, Bhavsar PK, Boffito M, Johnson MR, Pozniak A, Pelly M, Shabbir N, Connolly S, Cartier A, Jaffer S, Winpenny C, Daby D, Pepper S, Adamson C, Carungcong J, Nundlall K, Fedele S, Samson-Fessale P, Schoolmeesters A, Gomes de Almeida Martins L, Bull R, Correia Da Costa P, Bautista C, Eleanor Flores M, Maheswaran S, Macabodbod L, Houseman R, Svensson ML, Sayan A, Fung C, Garner J, Lai D, Nelson M, Moore L, Gidwani S, Davies G, Ouma B, Salinos C, Salha J, Yassein R, Abbasi A, Oblak M, Steward A, Thankachen M, Barker A, Fernandes C, Beatriz V, Flores L, Soler-Carracedo A, Rocca A, Maheswaran S, Martella C, Lloyd C, Nolan C, Horsford L, Martins L, Thomas L, Winstanley M, Bourke M, Branch N, Orhan O, Morton R, Saunder S, Patil S, Hughes S, Zhe W, De Leon A, Farah A, Rya G, Alizadeh K, Leong K, Trepte L, Goel N, McGown P, Kirwan U, Vilela Baião T, Marins L, Nazer S, Malaguthi de Souza R, Feitosa M, Lessa F, Silva de Magalhães E, Costenaro J, de Cassia Alves Lira R, Carolina A, Cauduro de Castro A, Machado Da Silva A, Kliemann D, De Cassia Alves Lira R, Walker G, Norton D, Lowthorpe V, Ivan M, Lillie P, Easom N, Sierra Madero J, López Iñiguez Á, Patricia Muñuzuri Nájera G, Paola Alarcón Murra C, Alanis Vega A, Muñoz Trejo T, Pérez Rodríguez O. Favipiravir in patients hospitalised with COVID-19 (PIONEER trial): a multicentre, open-label, phase 3, randomised controlled trial of early intervention versus standard care. Lancet Respir Med 2023; 11:415-424. [PMID: 36528039 PMCID: PMC9891737 DOI: 10.1016/s2213-2600(22)00412-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND COVID-19 has overwhelmed health services globally. Oral antiviral therapies are licensed worldwide, but indications and efficacy rates vary. We aimed to evaluate the safety and efficacy of oral favipiravir in patients hospitalised with COVID-19. METHODS We conducted a multicentre, open-label, randomised controlled trial of oral favipiravir in adult patients who were newly admitted to hospital with proven or suspected COVID-19 across five sites in the UK (n=2), Brazil (n=2) and Mexico (n=1). Using a permuted block design, eligible and consenting participants were randomly assigned (1:1) to receive oral favipiravir (1800 mg twice daily for 1 day; 800 mg twice daily for 9 days) plus standard care, or standard care alone. All caregivers and patients were aware of allocation and those analysing data were aware of the treatment groups. The prespecified primary outcome was the time from randomisation to recovery, censored at 28 days, which was assessed using an intention-to-treat approach. Post-hoc analyses were used to assess the efficacy of favipiravir in patients aged younger than 60 years, and in patients aged 60 years and older. The trial was registered with clinicaltrials.gov, NCT04373733. FINDINGS Between May 5, 2020 and May 26, 2021, we assessed 503 patients for eligibility, of whom 499 were randomly assigned to favipiravir and standard care (n=251) or standard care alone (n=248). There was no significant difference between those who received favipiravir and standard care, relative to those who received standard care alone in time to recovery in the overall study population (hazard ratio [HR] 1·06 [95% CI 0·89-1·27]; n=499; p=0·52). Post-hoc analyses showed a faster rate of recovery in patients younger than 60 years who received favipiravir and standard care versus those who had standard care alone (HR 1·35 [1·06-1·72]; n=247; p=0·01). 36 serious adverse events were observed in 27 (11%) of 251 patients administered favipiravir and standard care, and 33 events were observed in 27 (11%) of 248 patients receiving standard care alone, with infectious, respiratory, and cardiovascular events being the most numerous. There was no significant between-group difference in serious adverse events per patient (p=0·87). INTERPRETATION Favipiravir does not improve clinical outcomes in all patients admitted to hospital with COVID-19, however, patients younger than 60 years might have a beneficial clinical response. The indiscriminate use of favipiravir globally should be cautioned, and further high-quality studies of antiviral agents, and their potential treatment combinations, are warranted in COVID-19. FUNDING LifeArc and CW+.
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Affiliation(s)
- Pallav L Shah
- Chelsea & Westminster NHS Foundation Trust, London, UK,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial College London, London, UK,Correspondence to: Prof Pallav L Shah, Chelsea & Westminster NHS Foundation Trust, London SW10 9NH, UK
| | - Christopher M Orton
- Chelsea & Westminster NHS Foundation Trust, London, UK,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial College London, London, UK
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Gavin C Donaldson
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - James Tonkin
- Chelsea & Westminster NHS Foundation Trust, London, UK,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial College London, London, UK
| | - Breno R Santos
- Departamento de Infectología, Hospital Nossa Senhora da Conceição–Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Sandra W Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Andrew I Ritchie
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial College London, London, UK
| | - Francesca Conway
- Chelsea & Westminster NHS Foundation Trust, London, UK,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial College London, London, UK
| | - Maria P D Riberio
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Dexter J Wiseman
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial College London, London, UK
| | - Anand Tana
- Chelsea & Westminster NHS Foundation Trust, London, UK,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Bavithra Vijayakumar
- Chelsea & Westminster NHS Foundation Trust, London, UK,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial College London, London, UK
| | - Cielito Caneja
- Chelsea & Westminster NHS Foundation Trust, London, UK,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial College London, London, UK
| | - Craig Leaper
- Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Bobby Mann
- Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Anda Samson
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Pankaj K Bhavsar
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Marta Boffito
- Chelsea & Westminster NHS Foundation Trust, London, UK,National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Anton Pozniak
- Chelsea & Westminster NHS Foundation Trust, London, UK,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Pelly
- Chelsea & Westminster NHS Foundation Trust, London, UK
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Arendt M, Tasch B, Conway F, Lecomte A, Covi B, Mariani I, Valente EP, Lazzerini M. Quality of maternal and newborn care around the time of childbirth in Luxembourg during the COVID-19 pandemic: Results of the IMAgiNE EURO study. Int J Gynaecol Obstet 2022; 159 Suppl 1:113-125. [PMID: 36530011 PMCID: PMC9877667 DOI: 10.1002/ijgo.14473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate the quality of maternal and newborn care (QMNC) during childbirth in Luxembourg from women's perspectives. METHODS Women giving birth in facilities in Luxembourg between March 1, 2020, and July 1, 2021, answered a validated online WHO standards-based questionnaire as part of the multicountry IMAgINE EURO study. Descriptive and multivariate quantile regression analyses were performed. RESULTS A total of 493 women were included, representing 5.2% of women giving birth in the four maternity hospitals in Luxembourg during the study period. Most quality measures suggested high QMNC, although specific gaps were observed: 13.4% (n = 66) of women reported not being treated with dignity, 9.1% (n = 45) experienced abuse, 42.9% (n = 30) were not asked for consent prior to instrumental vaginal birth, 39.3% (n = 118) could not choose their birth position, 27% (n = 133) did not exclusively breastfeed at discharge (without significant differences over time), 20.5% (n = 101) reported an insufficient number of healthcare professionals, 20% (n = 25) did not receive information on the newborn after cesarean, and 41.2% (n = 203) reported lack of information on newborn danger signs before discharge. Multivariate analyses highlighted higher reported QMNC indexes among women born outside Luxembourg and delivering with a gynecologist, and significantly lower QMNC indexes in women with the highest education levels and those delivering in the hospital offering some private services. CONCLUSIONS Despite maternal reports suggesting an overall high QMNC in Luxembourg, improvements are needed in specific aspects of care and communication, mostly related to maternal autonomy, respect, and support, but also number and competencies of the health workforce.
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Affiliation(s)
- Maryse Arendt
- Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asblLuxembourgLuxembourg
| | - Barbara Tasch
- Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asblLuxembourgLuxembourg,Neonatal Intensive Care Unit, KannerKlinik, Centre Hospitalier de LuxembourgLuxembourgLuxembourg
| | - Francesca Conway
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Aline Lecomte
- Luxembourg Institute of Health, Department of Population Health/Public Health ExpertiseLuxembourgLuxembourg
| | - Benedetta Covi
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
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Conway F, Tonkin J, Valipour A, Pison C, Schumann C, Bonta PI, Kessler R, Gesierich W, Darwiche K, Lamprecht B, Skowasch D, Johnson PJ, Slebos DJ, Shah PL. Crossover Patient Outcomes for Targeted Lung Denervation in Moderate to Severe Chronic Obstructive Pulmonary Disease: AIRFLOW-2. Respiration 2022; 101:1069-1074. [PMID: 36302345 DOI: 10.1159/000527455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/06/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Targeted Lung Denervation (TLD) is a potential new therapy for COPD. Radiofrequency energy is bronchoscopically delivered to the airways to disrupt pulmonary parasympathetic nerves, to reduce bronchoconstriction, mucus hypersecretion, and bronchial hyperreactivity. OBJECTIVES This work assesses the effect of TLD on COPD exacerbations (AECOPD) in crossover subjects in the AIRFLOW-2 trial. METHOD The AIRFLOW-2 trial is a multicentre, randomized, double-blind, sham-controlled crossover trial of TLD in COPD. Patients with symptomatic COPD on optimal medical therapy with an FEV1 of 30-60% predicted received either TLD or sham bronchoscopy in a 1:1 randomization. Those in the sham arm had the opportunity to cross into the treatment arm after 12 months. The primary end point was rate of respiratory adverse events. Secondary end points included adverse events, changes in lung function and health-related quality of life and symptom scores. RESULTS Twenty patients were treated with TLD in the crossover phase and were subsequently followed up for 12 months (50% female, mean age 64.1 ± 6.9 years). After TLD, there was a trend towards a reduction in time to first AECOPD (hazard ratio 0.65, p = 0.28, not statistically significant) in comparison to sham follow-up period. There was also a reduction in time to first severe AECOPD in the crossover period (hazard ratio 0.38, p = 0.227, not statistically significant). Symptom scores and lung function showed stability. CONCLUSIONS AIRFLOW-2 crossover data support that of the randomization phase, showing trends towards reduction in COPD exacerbations with TLD.
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Affiliation(s)
- Francesca Conway
- Royal Brompton Hospital, Chelsea and Westminster Hospital, National Heart and Lung Institute, Imperial College, London, UK
| | - James Tonkin
- Royal Brompton Hospital, Chelsea and Westminster Hospital, National Heart and Lung Institute, Imperial College, London, UK
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Christophe Pison
- CHU Grenoble Alpes, Service Hospitalier Universitaire Pneumologie Physiologie, Inserm1055, Université Grenoble Alpes, Grenoble, France
| | - Christian Schumann
- Clinic of Pneumology, Thoracic Oncology, Sleep and Respiratory Critical Care, Kempten and Immenstadt, Allgäu, Germany
| | - Peter I Bonta
- Department of Respiratory Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Romain Kessler
- Service de Pneumologie, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France
| | - Wolfgang Gesierich
- Asklepios-Fachkliniken, Munich-Gauting, Comprehensive Pneumology Center Munich, Gauting, Germany
| | - Kaid Darwiche
- Department of Pulmonary Medicine, Section of Interventional Pneumology, Ruhrlandklinik - University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler Universitatsklinikum GmbH, Linz, Austria
| | - Dirk Skowasch
- Department of Internal Medicine II, Cardiology, Pneumology, University of Bonn, Bonn, Germany
| | | | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pallav L Shah
- Royal Brompton Hospital, Chelsea and Westminster Hospital, National Heart and Lung Institute, Imperial College, London, UK
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Russo C, Conway F, Siciliano T, Selntigia A, Giuseppe Martire F, Soreca G, Ticconi C, Exacoustos C. 3D transvaginal ultrasound diagnosis of uterine septa according to different classifications: are there other measurements that correlate to reproductive outcome in small indentation length? Facts Views Vis Obgyn 2022; 14:129-138. [DOI: 10.52054/fvvo.14.2.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: High discrepancy between current classifications was observed in the definition of uterine septa, especially for indentation lengths >5 <10mm.
Objectives: To assess the discrepancy between current classifications in the diagnoses of septate uterus and to correlate them with reproductive outcomes; to detect 3D transvaginal ultrasound (TVS) additional measurements, which can better correlate small indentation lengths >5 <10mm to reproductive failures.
Material and methods: Observational study enrolling 664 women of reproductive age with 3D ultrasound diagnosis of an indentation length ≥3mm. For each patient a detailed reproductive history was taken before performing 3D transvaginal examination. Patients with previous uterine surgery or metroplasty were excluded.
Main Outcome Measure(s): Indentation lengths >5 <10mm showed high discrepancy in the diagnosis of uterine septum between different classifications. For these small indentations additional 3D measurements (indentation angle, septal width and septal length/ fundal myometrial thickness (L/M) ratio) were correlated to infertility and recurrent miscarriage.
Results: Among the cohort, 215 patients showed an indentation length >5 <10mm; 136 tried to conceive: 69 (51%) were infertile, 38 (28%) had recurrent miscarriages (≥2) and 5 (4%) had at least one delivery. Recurrent miscarriage significantly correlated to an indentation angle >134°; whereas infertility to an indentation width <32mm and a L/M ratio >75%.
Conclusions: Wide discrepancies between different classifications are more evident in indentation lengths >5 <10mm. Additional measurements on 3D coronal section may help to evaluate the risk of infertility or recurrent miscarriage.
What is new? Additional 3D TVS measurements, beyond septal lengths, in particular for small fundal indentation, may help in predicting the risk of developing adverse reproductive outcomes.
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Hartman JE, Conway F, Degano B, Augustijn SWS, Herth FJF, Mayr A, Chacaroun S, Tonkin J, Valipour A, Slebos DJ. Rate of lung function decline slows in the 3 years after targeted lung denervation in COPD. Respir Med 2021; 188:106604. [PMID: 34543847 DOI: 10.1016/j.rmed.2021.106604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Jorine E Hartman
- Department of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
| | - Francesca Conway
- Imperial College London, London, United Kingdom; Royal Brompton Hospital, London, United Kingdom
| | - Bruno Degano
- CHU Grenoble Alpes, Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, France; Universite Grenoble Alpes, Grenoble, France
| | - Sonja W S Augustijn
- Department of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Felix J F Herth
- Thoraxklinik and Translational Lung Research Center Heidelberg, University of Heidelberg, Dep. of Pneumology and Critical Care Medicine, Heidelberg, Germany
| | - Anna Mayr
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
| | - Samarmar Chacaroun
- CHU Grenoble Alpes, Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, France
| | - James Tonkin
- Imperial College London, London, United Kingdom; Royal Brompton Hospital, London, United Kingdom
| | - Arschang Valipour
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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Del Prete A, Conway F, Della Rocca DG, Biondi-Zoccai G, De Felice F, Musto C, Picichè M, Martuscelli E, Natale A, Versaci F. COVID-19, Acute Myocardial Injury, and Infarction. Card Electrophysiol Clin 2021; 14:29-39. [PMID: 35221083 PMCID: PMC8556597 DOI: 10.1016/j.ccep.2021.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Martire FG, Zupi E, Lazzeri L, Morosetti G, Conway F, Centini G, Solima E, Pietropolli A, Piccione E, Exacoustos C. Reply. J Ultrasound Med 2021; 40:2259. [PMID: 33314192 DOI: 10.1002/jum.15594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Francesco G Martire
- Department of Surgical Sciences, Gynecologic Unit, University of Rome Tor Vergata, Rome, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Giulia Morosetti
- Department of Surgical Sciences, Gynecologic Unit, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Conway
- Department of Surgical Sciences, Gynecologic Unit, University of Rome Tor Vergata, Rome, Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Eugenio Solima
- Azienda Socio-Sanitaria Territoriale Fatebenefratelli, Hospital Sacco, Milan, Italy
| | - Adalgisa Pietropolli
- Department of Surgical Sciences, Gynecologic Unit, University of Rome Tor Vergata, Rome, Italy
| | - Emilio Piccione
- Department of Surgical Sciences, Gynecologic Unit, University of Rome Tor Vergata, Rome, Italy
| | - Caterina Exacoustos
- Department of Surgical Sciences, Gynecologic Unit, University of Rome Tor Vergata, Rome, Italy
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Martire FG, Zupi E, Lazzeri L, Morosetti G, Conway F, Centini G, Solima E, Pietropolli A, Piccione E, Exacoustos C. Transvaginal Ultrasound Findings After Laparoscopic Rectosigmoid Segmental Resection for Deep Infiltrating Endometriosis. J Ultrasound Med 2021; 40:1219-1228. [PMID: 32936475 DOI: 10.1002/jum.15505] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 08/14/2020] [Accepted: 08/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate transvaginal ultrasound (TVUS) findings in patients who underwent segmental rectosigmoid resection for deep infiltrating endometriosis (DIE) and to correlate postsurgical ultrasound findings with symptoms. METHODS A retrospective study including 50 premenopausal women with bowel endometriosis who underwent segmental rectosigmoid resection was conducted. Within 12 months after surgery, a TVUS examination was conducted in all patients to evaluate the presence of postsurgical endometriosis locations and symptoms, including dysmenorrhea, dyspareunia, dysuria, dyschezia, and chronic pelvic pain. Pelvic pain was assessed in all women by a visual analog scale. RESULTS At the follow-up 32 of 50 patients were receiving medical treatment, whereas 18 women declined postsurgical medical therapy and tried to conceive. A high percentage of adhesions (90%) was found. A negative sliding sign (a simple diagnostic sign that can be performed during a TVUS examination, consisting of gentle pressure applied by both the vaginal transducer and the examiner's hand on the abdomen; if the uterus does not glide freely along with the rectum and posterior fornix, the sign is considered negative, and adhesions can be suspected) was found in 29 (58%) women and was associated with bowel symptoms. Recurrence of posterior DIE was found in 9 cases (18%) and endometriomas in 8 cases (16%). Adenomyosis was observed in 80% of women and was present in all symptomatic patients. CONCLUSIONS After rectosigmoid segmental resection patients with DIE may continue to be symptomatic, and postoperative TVUS may reveal foci of disease or pelvic adhesions. Moreover, adenomyosis could be linked to symptoms experienced during follow up. Women should be aware that painful symptoms and alterations of pelvic organs could still be present after surgery and be detectable by TVUS.
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Affiliation(s)
- Francesco G Martire
- Department of Surgical Sciences, Gynecologic Unit, University of Rome Tor Vergata, Rome, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Giulia Morosetti
- Department of Surgical Sciences, Gynecologic Unit, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Conway
- Department of Surgical Sciences, Gynecologic Unit, University of Rome Tor Vergata, Rome, Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Eugenio Solima
- Azienda Socio Sanitaria Territoriale Fatebenefratelli, Hospital Sacco, Milan, Italy
| | - Adalgisa Pietropolli
- Department of Surgical Sciences, Gynecologic Unit, University of Rome Tor Vergata, Rome, Italy
| | - Emilio Piccione
- Department of Surgical Sciences, Gynecologic Unit, University of Rome Tor Vergata, Rome, Italy
| | - Caterina Exacoustos
- Department of Surgical Sciences, Gynecologic Unit, University of Rome Tor Vergata, Rome, Italy
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Klooster K, Valipour A, Marquette CH, Boutros J, Mal H, Marceau A, Shah PL, Conway F, Deslée G, Bourdin A, Pison C, Grah C, Hetzel M, Schumann C, Kessler R, Huebner RH, Skowasch D, Darwiche K, Hammerl P, Stanzel F, Bezzi M, Dutau H, Herth FJF, Slebos DJ. Endobronchial Coil System versus Standard-of-Care Medical Management in the Treatment of Subjects with Severe Emphysema. Respiration 2021; 100:804-810. [PMID: 33965944 DOI: 10.1159/000515744] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bronchoscopic lung volume reduction using endobronchial coils is a new treatment for patients with severe emphysema. To date, the benefits have been modest and have been suggested to be much larger in patients with severe hyperinflation and nonmulti-comorbidity. OBJECTIVE We aimed to evaluate the efficacy and safety of endobronchial coil treatment in a randomized multicenter clinical trial using optimized patient selection. METHOD Patients with severe emphysema on HRCT scan with severe hyperinflation (residual volume [RV] ≥200% predicted and RV/total lung capacity [TLC] >55%) were randomized to coil treatment or control. Primary outcome measures were differences in the forced expiratory volume in 1 s (FEV1) and St George's Respiratory Questionnaire (SGRQ) total score at 6 months. RESULTS Due to premature study termination, a total of 120 patients (age 63 ± 7 years, FEV1 29 ± 7% predicted, RV 251 ± 41% predicted, RV/TLC 67 ± 6%, and SGRQ 58 ± 13 points), instead of 210 patients, were randomized. At study termination, 91 patients (57 coil and 34 control) had 6-month results available. Analyses showed significantly greater improvements in favor of the coil group. The increase in FEV1 was greater in the coil group than that in the control group by + 10.3 [+4.7 to +16.0] % and in SGRQ by -10.6 [-15.9 to -5.4] points. At study termination, there were 5 (6.8%) deaths in the coil cohort reported. CONCLUSION Despite early study termination, coil treatment compared to control results in a significant improvement in the lung function and quality of life benefits for up to 6 months in patients with emphysema and severe hyperinflation. These improvements were of clinical importance but were associated with a higher likelihood of serious adverse events.
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Affiliation(s)
- Karin Klooster
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arschang Valipour
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Floridsdorf, Austria
| | | | - Jacques Boutros
- Université Côte d'Azur, FHU OncoAge, CHU de Nice, Nice, France
| | - Hervé Mal
- Hôpital Bichat - Claude Bernard, Paris, France
| | | | - Pallav L Shah
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Francesca Conway
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | | | | | | | - Christian Grah
- Gemeinschaftskrankenhaus Havelhöhe GmbH, Berlin, Germany
| | - Martin Hetzel
- Krankenhaus vom Roten Kreuz Bad Cannstatt GmbH, Stuttgart, Germany
| | | | | | | | | | - Kaid Darwiche
- Department for Interventional Pneumology, Ruhrlandklinik - University Medicine Essen, Essen, Germany
| | | | | | | | | | - Felix J F Herth
- Department of Internal Medicine, Pulmonary and Critical Care Medicine Thoraxklinik and Translational Lung Research Center Heidelberg University Heidelberg, Heidelberg, Germany
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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11
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Valipour A, Shah PL, Herth FJ, Pison C, Schumann C, Hübner RH, Bonta PI, Kessler R, Gesierich W, Darwiche K, Lamprecht B, Perez T, Skowasch D, Deslee G, Marceau A, Sciurba FC, Gosens R, Hartman JE, Conway F, Duller M, Mayse M, Norman HS, Slebos DJ. Two-Year Outcomes for the Double-Blind, Randomized, Sham-Controlled Study of Targeted Lung Denervation in Patients with Moderate to Severe COPD: AIRFLOW-2. Int J Chron Obstruct Pulmon Dis 2020; 15:2807-2816. [PMID: 33177818 PMCID: PMC7652218 DOI: 10.2147/copd.s267409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose COPD exacerbations are associated with worsening clinical outcomes and increased healthcare costs, despite use of optimal medical therapy. A novel bronchoscopic therapy, targeted lung denervation (TLD), which disrupts parasympathetic pulmonary innervation of the lung, has been developed to reduce clinical consequences of cholinergic hyperactivity and its impact on COPD exacerbations. The AIRFLOW-2 study assessed the durability of safety and efficacy of TLD additive to optimal drug therapy compared to sham bronchoscopy and optimal drug therapy alone in subjects with moderate-to-severe, symptomatic COPD two years post randomization. Patients and Methods TLD was performed in COPD patients (FEV1 30-60% predicted, CAT≥10 or mMRC≥2) in a 1:1 randomized, sham-controlled, double-blinded multicenter study (AIRFLOW-2) using a novel lung denervation system (Nuvaira, Inc., USA). Subjects remained blinded until their 12.5-month follow-up visit when control subjects were offered the opportunity to undergo TLD. A time-to-first-event analysis on moderate and severe and severe exacerbations of COPD was performed. Results Eighty-two subjects (FEV1 41.6±7.4% predicted, 50.0% male, age 63.7±6.8 yrs, 24% with prior year respiratory hospitalization) were randomized. Time-to-first severe COPD exacerbation was significantly lengthened in the TLD arm (p=0.04, HR=0.38) at 2 years post-TLD therapy and trended towards similar attenuation for moderate and severe COPD exacerbations (p=0.18, HR=0.71). No significant changes in lung function or SGRQ-C were found 2 years post randomization between groups. Conclusion In a randomized trial, TLD demonstrated a durable effect of significantly lower risk of severe AECOPD over 2 years. Further, lung function and quality of life remained stable following TLD. Clinical Trial Registration NCT02058459.
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Affiliation(s)
- Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | - Pallav L Shah
- Royal Brompton & Harefield NHS Trust, Chelsea & Westminster Hospital and Imperial College, London, UK
| | - Felix J Herth
- Thoraxklinik, Department of Pneumology and Critical Care Medicine and Translational Lung Research Center Heidelberg (TLRCH), University of Heidelberg, Heidelberg, Germany
| | - Christophe Pison
- CHU Grenoble Alpes, Service Hospitalier Universitaire Pneumologie Physiologie; Université Grenoble Alpes, Grenoble, France
| | - Christian Schumann
- Clinic of Pneumology, Thoracic Oncology, Sleep- and Respiratory Critical Care, Klinikverbund Allgaeu, Kempten and Immenstadt, Germany
| | - Ralf-Harto Hübner
- Charité Universitätsmedizin Berlin, Medizinische Klinik m. Schw. Infektiologie und Pneumologie, Campus Virchow, Berlin, Germany
| | - Peter I Bonta
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Romain Kessler
- Service de Pneumologie, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France
| | - Wolfgang Gesierich
- Asklepios-Fachkliniken Munich-Gauting, Comprehensive Pneumology Center Munich, Gauting, Germany
| | - Kaid Darwiche
- Department of Pulmonary Medicine, Section of Interventional Pneumology, Ruhrlandklinik - University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler Universitatsklinikum GmbH, Linz, Austria
| | | | - Dirk Skowasch
- Department of Internal Medicine II - Cardiology/Pneumology, University of Bonn, Bonn, Germany
| | - Gaetan Deslee
- CHU de Reims, Hôpital Maison Blanche, Service de Pneumologie, Reims, France
| | - Armelle Marceau
- Service de Pneumologie, Hôpital Universitaire Bichat, Paris, France
| | - Frank C Sciurba
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Reinoud Gosens
- Department of Molecular Pharmacology, University of Groningen, Groningen, the Netherlands
| | - Jorine E Hartman
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Francesca Conway
- Royal Brompton & Harefield NHS Trust, Chelsea & Westminster Hospital and Imperial College, London, UK
| | - Marina Duller
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | | | | | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - On behalf of the AIRFLOW-2 Trial Study Group
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
- Royal Brompton & Harefield NHS Trust, Chelsea & Westminster Hospital and Imperial College, London, UK
- Thoraxklinik, Department of Pneumology and Critical Care Medicine and Translational Lung Research Center Heidelberg (TLRCH), University of Heidelberg, Heidelberg, Germany
- CHU Grenoble Alpes, Service Hospitalier Universitaire Pneumologie Physiologie; Université Grenoble Alpes, Grenoble, France
- Clinic of Pneumology, Thoracic Oncology, Sleep- and Respiratory Critical Care, Klinikverbund Allgaeu, Kempten and Immenstadt, Germany
- Charité Universitätsmedizin Berlin, Medizinische Klinik m. Schw. Infektiologie und Pneumologie, Campus Virchow, Berlin, Germany
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Service de Pneumologie, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France
- Asklepios-Fachkliniken Munich-Gauting, Comprehensive Pneumology Center Munich, Gauting, Germany
- Department of Pulmonary Medicine, Section of Interventional Pneumology, Ruhrlandklinik - University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Pulmonary Medicine, Kepler Universitatsklinikum GmbH, Linz, Austria
- CHU de Lille – Hôpital Calmette, Lille, France
- Department of Internal Medicine II - Cardiology/Pneumology, University of Bonn, Bonn, Germany
- CHU de Reims, Hôpital Maison Blanche, Service de Pneumologie, Reims, France
- Service de Pneumologie, Hôpital Universitaire Bichat, Paris, France
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Molecular Pharmacology, University of Groningen, Groningen, the Netherlands
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Nuvaira, Inc., Minneapolis, MN, USA
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12
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Martire FG, Lazzeri L, Conway F, Siciliano T, Pietropolli A, Piccione E, Solima E, Centini G, Zupi E, Exacoustos C. Adolescence and endometriosis: symptoms, ultrasound signs and early diagnosis. Fertil Steril 2020; 114:1049-1057. [PMID: 33036795 DOI: 10.1016/j.fertnstert.2020.06.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the ultrasonographic presence of different forms of endometriosis and the associated clinical symptoms in adolescent women. DESIGN Retrospective observational study. SETTING University hospital. PATIENT(S) Two hundred and seventy women aged 12-20 years referred to the gynecologic ultrasound unit from January 2014 to June 2019. INTERVENTION(S) Two-dimensional, three-dimensional, and power Doppler ultrasound (US) pelvic examination (transvaginal or transrectal in pre-sexually active adolescents) were performed in all included adolescents. Medical history was collected for each patient before the scan. MAIN OUTCOME MEASURE(S) All possible locations of endometriosis evaluated and recorded using a dedicated ultrasound mapping sheet and severity of painful symptoms evaluated through a visual analogue scale (VAS). RESULT(S) Dysmenorrhea was detected in 147 (54.4%) of 270 patients and heavy menstrual bleeding in 76 (28.1%) of 270. At least one ultrasound feature of endometriosis was identified in 36 (13.3%) of 270 cases. Ovarian endometriomas were found in 22 (11%) patients, adenomyosis in 16 (5.2%), and deep infiltrating endometriosis (DIE) in 10 (3.7%). Ultrasound signs of endometriosis were found in 21% of adolescents who reported dysmenorrhea and 33% with dyspareunia. The presence of DIE at ultrasound was associated with bowel symptoms in 33% of patients and associated with dyspareunia in 25% of patients. CONCLUSION(S) The detection rate of pelvic endometriotic lesions at ultrasound was 13%. The rates of dysmenorrhea, dyspareunia and heavy menstrual bleeding in adolescents with endometriosis ultrasound signs were statistically significantly higher compared with those without. In patients with dysmenorrhea, the detection rate of pelvic endometriosis at ultrasound increased to 20%. Professionals involved with teens should be aware of the clinical presentation of endometriosis to reduce the delay between the onset of symptoms and the diagnosis, referring these young women to dedicated centers.
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Affiliation(s)
- Francesco G Martire
- Department of Surgical Science, Gynecological Unit, University of Rome "Tor Vergata," Rome, Italy.
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Francesca Conway
- Department of Surgical Science, Gynecological Unit, University of Rome "Tor Vergata," Rome, Italy
| | - Terry Siciliano
- Department of Surgical Science, Gynecological Unit, University of Rome "Tor Vergata," Rome, Italy
| | - Adalgisa Pietropolli
- Department of Surgical Science, Gynecological Unit, University of Rome "Tor Vergata," Rome, Italy
| | - Emilio Piccione
- Department of Surgical Science, Gynecological Unit, University of Rome "Tor Vergata," Rome, Italy
| | | | - Gabriele Centini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Caterina Exacoustos
- Department of Surgical Science, Gynecological Unit, University of Rome "Tor Vergata," Rome, Italy
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Exacoustos C, Conway F, Russo C, Martire FG, Siciliano T, Cosentino M, Ticconi C. SMALL UTERINE SEPTA: ARE THERE OTHER 3D ULTRASOUND MEASUERMENTS BEYOND SEPTAL LENGTH THAT BETTER CORRELATE TO REPRODUCTIVE OUTCOME? Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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La Rosa VL, Barra F, Chiofalo B, Platania A, Di Guardo F, Conway F, Di Angelo Antonio S, Lin LT. An overview on the relationship between endometriosis and infertility: the impact on sexuality and psychological well-being. J Psychosom Obstet Gynaecol 2020; 41:93-97. [PMID: 31466493 DOI: 10.1080/0167482x.2019.1659775] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose: Women with endometriosis represent a significant proportion of all outpatient gynecological consultations. Endometriosis is a benign chronic condition characterized by the spreading of endometrial-like tissue outside the uterus. A correlation between endometriosis and infertility has been strongly underlined in the literature about the topic: recent data suggest that up to 50% of women with infertility may suffer from this disease. The aim of this brief commentary is to focus the attention on the importance of a multidisciplinary approach for patients with endometriosis, including an accurate psychological and sexological counselling.Materials and Methods: We propose a brief point of view about a multidisciplinary approach in the treatment of endometriosis and associated infertility.Results and conclusions: Endometriosis is associated to a worse quality of life. Women with endometriosis also report higher levels of psychological conditions such as anxiety and depression. For this reason, an integrative approach is strongly advisable in order to improve social functions and mental health of these women and their partners. This may allow a more correct therapeutic management of these patients, reducing the potential negative impact of the disease on the mental wellbeing of the couple.
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Affiliation(s)
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynaecology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, "Regina Elena" National Cancer Institute, Rome, Italy
| | | | - Federica Di Guardo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Francesca Conway
- Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Silvia Di Angelo Antonio
- Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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15
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Guerriero S, Conway F, Pascual MA, Graupera B, Ajossa S, Neri M, Musa E, Pedrassani M, Alcazar JL. Ultrasonography and Atypical Sites of Endometriosis. Diagnostics (Basel) 2020; 10:diagnostics10060345. [PMID: 32471042 PMCID: PMC7345680 DOI: 10.3390/diagnostics10060345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 12/18/2022] Open
Abstract
In the present pictorial we show the ultrasonographic appearances of endometriosis in atypical sites. Scar endometriosis may present as a hypoechoic solid nodule with hyperechoic spots while umbilical endometriosis may appear as solid or partially cystic areas with ill-defined margins. In the case of endometriosis of the rectus muscle, ultrasonography usually demonstrates a heterogeneous hypoechogenic formation with indistinct edges. Inguinal endometriosis is quite variable in its ultrasonographic presentation showing a completely solid mass or a mixed solid and cystic mass. The typical ultrasonographic finding associated with perineal endometriosis is the presence of a solid lesion near to the episiotomy scar. Under ultrasonography, appendiceal endometriosis is characterized by a solid lesion in the wall of the small bowel, usually well defined. Superficial hepatic endometriosis is characterized by a small hypoechoic lesion interrupting the hepatic capsula, usually hyperechoic. Ultrasound endometriosis of the pancreas is characterized by a small hypoechoic lesion while endometriosis of the kidney is characterized by a hyperechoic small nodule. Diaphragmatic endometriosis showed typically small hypoechoic lesions. Only peripheral nerves can be investigated using ultrasound, with a typical solid appearance. In conclusion, ultrasonography seems to have a fundamental role in the majority of endometriosis cases in "atypical" sites, in all the cases where "typical" clinical findings are present.
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Affiliation(s)
- Stefano Guerriero
- Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; (F.C.); (S.A.); (M.N.); (E.M.)
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy
- Correspondence:
| | - Francesca Conway
- Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; (F.C.); (S.A.); (M.N.); (E.M.)
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy
| | - Maria Angela Pascual
- Department of Obstetrics, Gynecology and Reproduction, Hospital UniversitariDexeus, 08028 Barcelona, Spain; (M.A.P.); (B.G.)
| | - Betlem Graupera
- Department of Obstetrics, Gynecology and Reproduction, Hospital UniversitariDexeus, 08028 Barcelona, Spain; (M.A.P.); (B.G.)
| | - Silvia Ajossa
- Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; (F.C.); (S.A.); (M.N.); (E.M.)
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy
| | - Manuela Neri
- Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; (F.C.); (S.A.); (M.N.); (E.M.)
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy
| | - Eleonora Musa
- Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; (F.C.); (S.A.); (M.N.); (E.M.)
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy
| | - Marcelo Pedrassani
- Hospital Maternidade Carmela Dutra and ClinusClínica de Imagem, Florianopolis 88015–270, Brazil;
| | - Juan Luis Alcazar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, 31008 Pamplona, Navara, Spain;
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16
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Exacoustos C, Morosetti G, Conway F, Camilli S, Martire FG, Lazzeri L, Piccione E, Zupi E. New Sonographic Classification of Adenomyosis: Do Type and Degree of Adenomyosis Correlate to Severity of Symptoms? J Minim Invasive Gynecol 2019; 27:1308-1315. [PMID: 31600574 DOI: 10.1016/j.jmig.2019.09.788] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/26/2019] [Accepted: 09/26/2019] [Indexed: 12/26/2022]
Abstract
STUDY OBJECTIVE To correlate the type and degree of adenomyosis, scored through a new system based on the features of transvaginal sonography, to patients' symptoms and fertility. DESIGN This is a multicenter, observational, prospective study. SETTING Two endometriosis tertiary referral centers (University of Rome "Tor Vergata" and University of Siena). PATIENTS A total of 108 patients with ultrasonographic signs of adenomyosis. INTERVENTIONS A new ultrasonographic scoring system designed to assess the severity and the extent of uterine adenomyosis was used to stage the disease in correlation with the clinical symptoms. Menstrual uterine bleeding was assessed by a pictorial blood loss analysis chart, painful symptoms were evaluated using a visual analog scale, and infertility factors were considered. MEASUREMENTS AND MAIN RESULTS A total of 108 patients with ultrasonographic signs of adenomyosis (mean age ± standard deviation, 37.7 ± 7.7 years) were classified according to the proposed scoring system. Women with ultrasound diagnosis of diffuse adenomyosis were older (p = .04) and had heavier menstrual bleeding (p = .04) than women with focal disease; however, no statistically significant differences were found regarding the presence and severity of dyspareunia and dysmenorrhea. Higher values of menstrual bleeding were found for severe diffuse adenomyosis, with the highest values being found in those with adenomyomas. In patients trying to conceive, the presence of ultrasound findings of focal disease was associated with a higher percentage of infertility than in those with diffuse disease, and the focal involvement of the junctional zone showed a higher percentage of at least 1 miscarriage than in those with diffuse adenomyosis. CONCLUSION The ultrasonographic evaluation of the type and extension of adenomyosis in the myometrium seems to be important in correlation to the severity of symptoms and infertility.
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Affiliation(s)
- Caterina Exacoustos
- Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic, University of Rome "Tor Vergata" (Drs. Exacoustos, Morosetti, Conway, Camilli, Giuseppe Martire, Piccione, and Zupi), Rome
| | - Giulia Morosetti
- Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic, University of Rome "Tor Vergata" (Drs. Exacoustos, Morosetti, Conway, Camilli, Giuseppe Martire, Piccione, and Zupi), Rome
| | - Francesca Conway
- Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic, University of Rome "Tor Vergata" (Drs. Exacoustos, Morosetti, Conway, Camilli, Giuseppe Martire, Piccione, and Zupi), Rome
| | - Sara Camilli
- Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic, University of Rome "Tor Vergata" (Drs. Exacoustos, Morosetti, Conway, Camilli, Giuseppe Martire, Piccione, and Zupi), Rome
| | - Francesco Giuseppe Martire
- Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic, University of Rome "Tor Vergata" (Drs. Exacoustos, Morosetti, Conway, Camilli, Giuseppe Martire, Piccione, and Zupi), Rome
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena (Dr. Lazzeri), Siena, Italy..
| | - Emilio Piccione
- Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic, University of Rome "Tor Vergata" (Drs. Exacoustos, Morosetti, Conway, Camilli, Giuseppe Martire, Piccione, and Zupi), Rome
| | - Errico Zupi
- Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic, University of Rome "Tor Vergata" (Drs. Exacoustos, Morosetti, Conway, Camilli, Giuseppe Martire, Piccione, and Zupi), Rome
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Guardo FD, Currò JM, Valenti G, Rossetti P, Di Gregorio LM, Conway F, Chiofalo B, Garzon S, Bruni S, Rizzo G. Non-pharmacological management of gestational diabetes: The role of myo-inositol. J Complement Integr Med 2019; 17:/j/jcim.ahead-of-print/jcim-2019-0111/jcim-2019-0111.xml. [PMID: 31527297 DOI: 10.1515/jcim-2019-0111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/03/2019] [Indexed: 12/29/2022]
Abstract
Gestational diabetes mellitus (GDM) is the most common metabolic disorder occurring in pregnancy. GDM plays an important role in the current diabetes epidemic: exposure to a high glycemic environment during the early stages of development increases the risk of the fetus to develop type two diabetes mellitus (T2DM) in adult life. Various cardiometabolic risk factors are linked to GDM. A thorough knowledge of the risk factors and genes involved in the development of GDM, along with an understanding of the underlying pathophysiological mechanisms are crucial to properly identify patients at risk of developing this condition. There is growing evidence showing that myo-inositol, combined with an appropriate therapeutic regimen for GDM, can provide additional benefits to the patient. The aim of this review is to analyze the role of inositol isomers - especially myo-inositol (MYO-INS) - in the treatment of patients with GDM.
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Affiliation(s)
- Federica Di Guardo
- Department of General Surgery and Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Catania, Italy
| | | | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Catania, Italy
| | - Paola Rossetti
- Unit of Diabetology and Endocrino-Metabolic Diseases, Hospital for Emergency Cannizzaro, Catania, Italy
| | - Luisa Maria Di Gregorio
- Department of General Surgery and Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Catania, Italy
| | - Francesca Conway
- Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Simone Bruni
- Division of Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Conway F, Morosetti G, Camilli S, Martire FG, Sorrenti G, Piccione E, Zupi E, Exacoustos C. Ulipristal acetate therapy increases ultrasound features of adenomyosis: a good treatment given in an erroneous diagnosis of uterine fibroids. Gynecol Endocrinol 2019; 35:207-210. [PMID: 30382803 DOI: 10.1080/09513590.2018.1505846] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Ulipristal acetate (UPA) is used for medical treatment of uterine fibroids. The aim of this study was to describe the effects on painful symptoms and the sonographic uterine modifications in patients with adenomyosis erroneously treated with UPA. This is an observational study on six women affected by adenomyosis and treated with three months of UPA (5 mg/24h). The baseline ultrasonography (US) was not performed at out center nor was the diagnosis of fibroids. The patients came to our attention after the treatment with UPA, prescribed by an external physician. During our post-treatment scan we found aspects of adenomyosis, while no fibroids were detected. Symptoms, myometrial and endometrial ultrasound features were evaluated. All patients reported an increase in pelvic pain. At US evaluation intramyometrial cystic areas were found in all six cases (100%). All patients showed an enhancement of adenomyosis features.The intra-myometrial cysts appeared enlarged and the vascularization enhanced when compared to the images of the pretreatment scan. In patients with adenomyosis treated with UPA due to an erroneous diagnosis of uterine fibroids we observed a worsening of the US features of adenomyosis and of the painful symptoms.
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Affiliation(s)
- Francesca Conway
- a Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic , University of Rome "Tor Vergata" , Roma , Italy
| | - Giulia Morosetti
- a Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic , University of Rome "Tor Vergata" , Roma , Italy
| | - Sara Camilli
- a Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic , University of Rome "Tor Vergata" , Roma , Italy
| | - Francesco Giuseppe Martire
- a Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic , University of Rome "Tor Vergata" , Roma , Italy
| | - Giuseppe Sorrenti
- a Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic , University of Rome "Tor Vergata" , Roma , Italy
| | - Emilio Piccione
- a Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic , University of Rome "Tor Vergata" , Roma , Italy
| | - Errico Zupi
- a Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic , University of Rome "Tor Vergata" , Roma , Italy
| | - Caterina Exacoustos
- a Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic , University of Rome "Tor Vergata" , Roma , Italy
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Conway F, Dubrey S. Coils to aid recoil: a bronchoscopic approach to lung reduction surgery in emphysema. Br J Hosp Med (Lond) 2018; 79:51. [PMID: 29315038 DOI: 10.12968/hmed.2018.79.1.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Francesca Conway
- CT2 in Cardiology, Department of Cardiology, Hillingdon Hospital, Uxbridge, Middlesex
| | - Simon Dubrey
- Consultant Cardiologist, Department of Cardiology, Hillingdon Hospital, Uxbridge, Middlesex UB8 3NN
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Exacoustos C, Camilli S, Conway F, Di Giovanni A, De Felice G, Piccione E, Zupi E. Ultrasound Characteristics of Highly Vascularized Uterine Myomas: Correlation to Histopathology. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chiofalo B, Palmara V, Laganà AS, Triolo O, Vitale SG, Conway F, Santoro G. Fertility Sparing Strategies in Patients Affected by Placental Site Trophoblastic Tumor. Curr Treat Options Oncol 2017; 18:58. [PMID: 28840513 DOI: 10.1007/s11864-017-0502-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OPINION STATEMENT Placental site trophoblastic tumor (PSTT) is the least common and the most ambiguous gestational trophoblastic tumor. Presentation of PSTT may occur in the course of gestation or from 1 week to 14 years after a normal or an abnormal pregnancy (mole, ectopic pregnancy, abortion). The indicators of aggressive behavior for this tumor are not well established. Due to the rarity of this disease that usually affects women of childbearing potential, we aimed to review the current literature, to identify risk factors and the best conservative therapeutic choices among the cases described. We performed a systematic literature search of articles in English language, published from 1996 to 2017 and indexed in PubMed and Scopus. Based on selective inclusion/exclusion criteria, we considered eight papers eligible for the review. Five were case reports and three were retrospective studies. We extracted and organized data into three different categories depending on the main treatment used. A total of 12 cases were treated with laparotomy; in 5 cases, the treatment was not curative. Therefore, a total abdominal hysterectomy was needed. Five cases were treated successfully with a minimally invasive approach, 2 with uterine evacuation, 2 with hysteroscopic resection, and 1 with a combined hysteroscopic/laparoscopic resection. Only 1 case treated with exclusive chemotherapy proved curative for the patient. Preservation of fertility in PSTT patients of childbearing age should be considered and as showed by the abovementioned studies, is a possible and safe therapeutic choice. Laparotomy for local uterine resection with the modified Strassman approach could be offered in patients at clinical stage 1 that are very motivated to retain fertility, extensively informing the patient of the risks and benefits related to this choice.
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Affiliation(s)
- Benito Chiofalo
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Vittorio Palmara
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Antonio Simone Laganà
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Onofrio Triolo
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Salvatore Giovanni Vitale
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Francesca Conway
- Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Santoro
- Department of Biomedical and Dental Sciences and Morpho-Functional Images, University of Messina, 1st floor Biologic Tower, Messina, Italy.
- Department of Biomedical and Dental Sciences and Morpho-Functional Images, A.O.U. Policlinic "G. Martino", 1st floor Biologic Tower, Via Consolare Valeria, 98125, Messina, Italy.
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Conway F, Majeed A, Easton G. Authors' reply to Brusasco and colleagues and Quanjer and colleagues. BMJ 2016; 352:i400. [PMID: 26822680 DOI: 10.1136/bmj.i400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Francesca Conway
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Graham Easton
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
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Affiliation(s)
- Francesca Conway
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Graham Easton
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
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Critchley LA, Conway F, Anderson PJ, Tomlinson B, Critchley JA. Non-invasive continuous arterial pressure, heart rate and stroke volume measurements during graded head-up tilt in normal man. Clin Auton Res 1997; 7:97-101. [PMID: 9174658 DOI: 10.1007/bf02267754] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The haemodynamic effects of head-up tilt (HUT) at different tilt angles were investigated non-invasively in eight normal male subjects. Mean arterial pressure (MAP; by Ohmeda Finapres 2300), stroke volume (SV) and heart rate (HR; by BoMed NCCOM3-R7S) were continuously recorded whilst performing a series of HUTs (55 degrees, 10 degrees, 20 degrees, 30 degrees and 55 degrees) lasting 3 min each. The response to HUT was proportional to the sinc of the tilt angle. The magnitude of the response varied between subjects. HUT to 55 degrees resulted in mean (95% confidence limits) increases in MAP by 16 (+/-16)% and HR by 11 (+/-24)% and a decrease in SV by -25 (+/-22)%. These results were repeatable after 30 min. At small tilt angles, i.e. < or = 20 degrees, MAP did not change and HR decreased by -3 (+/-4)%. A detailed analysis revealed immediate dynamic (0-30 s), late dynamic (30-90 s) and plateau (after 90 s) phases in the response to HUT. In conclusion, HUT produces reproducible haemodynamic effects, although differences exist among subjects. A detailed analysis of these effects can be successfully performed using non-invasive methods.
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Affiliation(s)
- L A Critchley
- Departments of Anaesthesia & Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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Abstract
We have studied 45 patients, aged 60-95 yr, receiving subarachnoid block for neck of femur fractures. Patient received either colloid (polygeline, Haemaccel) 8 ml kg-1 (n = 15), metaraminol 5 micrograms kg-1 and 1.7 micrograms kg-1 min-1 (n = 15) or a combination of both treatments to maintain systolic arterial pressure (SAP) between 75 and 100% of baseline. If necessary, additional colloid 2 x 4 ml kg-1 or metaraminol 3 x 2.5 micrograms kg-1 was given. Arterial pressure was measured by automated oscillotonometry, central venous pressure (CVP) by a manometer and cardiac index (CI), stoke index (SI) and heart rate (HR) by transthoracic electrical bioimpedance. Systemic vascular resistance index (SVRI) was derived. Colloid was less effective than metaraminol (P < 0.05). In the colloid group, SAP and SVRI decreased and CVP, CI and SI increased (P < 0.001). In the metaraminol group, initial decreases in SAP, SVRI and CVP were restored after 10-15 min and HR decreased after 12 min (P < 0.001). In the combined group, initial decreases in SAP and SVRI were restored after 4 and 16 min, and CVP, CI, SI and HR increased (P < 0.001). Metaraminol was more effective than colloid because it increased SVRI, whereas colloid increased CVP without significantly increasing CI.
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Affiliation(s)
- L A Critchley
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong
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Abstract
PURPOSE Children scheduled to undergo otoplasty experience severe pain postoperatively. Nausea and vomiting is also a problem. This study was designed to compare two analgesic techniques (i) regional nerve blockade (ii) local anaesthetic infiltration, with respect to quality and duration of analgesia, opioid requirements and the incidence of postoperative nausea and vomiting (PONV). METHODS Forty three children, ASA I-II, aged 3-15 yr, were studied and followed for 24 hr postoperatively. Patients were randomised into two groups. Patients in Group A received local infiltration with lidocaine 1% with adrenaline 1:200,000 0.4 ml.kg-1 (n = 21). Patients in Group B (n = 22) received nerve blockade, bupivacaine 0.5%, 0.4 ml.kg-1. No other form of analgesia was used intraoperatively. Quality and duration of analgesia were assessed using pain and sedation scores recorded by a blinded observer at 0, 5, 10, 15, 30, 45 min with Recovery Room, and at 0, 30, 60, 90, 120, 180, 240, 360, 480 min on the ward. Pain score > 6 was treated with fentanyl 1 microgram.kg-1 iv (recovery) and morphine 0.2 mg.kg-1 im or mefenamic acid 8 mg.kg-1 po on the ward. Time to first supplemental analgesia was noted. Mean duration of analgesia was 8.6 (1.1-24) hr, Group A and 10.5 (1.3-24) hr, Group B (P > 0.7). 24% per cent of children (Group A) and 27% (Group B) required no supplemental analgesia (P > 0.6). The degree of pain control resulted in a low requirement for opioids, Group A: 24%, Group B: 14% (P:NS). The overall incidence of PONV was 43% (Group A) and 36% (Group B) (P:NS): PONV correlated with opioid use. There were no differences between the groups with regard to pain/sedation scores, quality/duration of analgesia, opioid requirements and incidence of PONV. CONCLUSION Both techniques provided excellent postoperative analgesia. Lidocaine 1% infiltration (adrenaline 1:200,000) has the added advantage of improving surgical field and haemostasis. Thus, we advocate use of the simpler technique.
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Affiliation(s)
- N Cregg
- Department of Anaesthesia, Our Lady's Hospital for Sick Children, Dublin, Ireland
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Conway F, Critchley LA, Stuart JC, Freebairn RC. A comparison of the haemodynamic effects of intrathecal meperidine, meperidine-bupivacaine mixture and hyperbaric bupivacaine. Can J Anaesth 1996; 43:23-9. [PMID: 8665630 DOI: 10.1007/bf03015953] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To study the haemodynamic effects of intrathecal meperidine, administered either alone or mixed with bupivacaine. METHODS We studied 42 Chinese patients, aged 59-87 yr, scheduled for transurethral bladder or prostate surgery, randomized into three equals groups, that received either meperidine 0.8 mg.kg-1, meperidine 0.4 mg.kg-1 plus 1.5 ml of 0.5% heavy bupivacaine or 3 ml of heavy bupivacaine 0.5%. Non-invasive systolic (SAP) and mean (MAP) arterial pressures, central venous pressure and cardiac index, stroke index and heart rate (HR) measured by the BoMed NCCOM3-R7S bioimpedance device, were recorded over the first 25 min. Systemic vascular resistance index (SVRI) was derived. Onset of sensory and motor block was also measured. Decreases in MAP of 25% were treated with colloid and metaraminol. RESULTS The onset of block was slower in the meperidine group (P < 0.05). Decreases in SAP, MAP and SVRI (all; P < 0.001) occurred within five minutes in all three groups. The HR was increased in the bupivacaine group (P = 0.03), but bradycardias treated with atropine occurred in six patients receiving meperidine and four patients receiving the mixture. Six patients receiving meperidine and two patients receiving the mixture required general anaesthesia for inadequate block. The incidence of nausea and vomiting was higher in the patients receiving meperidine (P < 0.05). No other complications were encountered. CONCLUSIONS Intrathecal meperidine used alone or mixed with bupivacaine has no intra-operative advantage over heavy bupivacaine 0.5%.
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Affiliation(s)
- F Conway
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin
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Lyons B, Cregg N, Conway F, Casey W, Doherty P, Moore KP. Premedication for ambulatory surgery in preschool children: a comparison of oral midazolam and rectal thiopentone. Can J Anaesth 1995; 42:473-8. [PMID: 7628025 DOI: 10.1007/bf03011683] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Seventy five ASA 1 and 2 children, aged between six months and five years were randomized to receive oral midazolam 0.5 mg.kg-1, rectal thiopentone 35 mg.kg-1 or no premedication to compare the safety and efficacy of, and parental attitudes to, both premedicants. Cardio-respiratory variables were from the time of premedication to awakening from anaesthesia. In addition, anxiety and sedation scores and patients' acceptance of both premedicant and mask at induction, were all recorded using four-point rating scales. Times to recovery and discharge, and parental satisfaction with the premedication their child had received were also recorded. Children receiving rectal thiopentone had higher sedation scores and were more accepting of the mask than were the other two groups (P < 0.001). Their acceptance of the premedication was similar to that of the midazolam group. Times to spontaneous eye opening and discharge were longer in the thiopentone group (P < 0.005). Parental preoperative satisfaction rating was higher for thiopentone, but not midazolam, than no premedication (P < 0.05). When asked their premedication preferences for subsequent general anaesthetics, a higher proportion of parents whose children were not premedicated requested an alternative regimen (P < 0.01). In conclusion the study found that premedication with rectal thiopentone provided superior induction characteristics to oral midazolam, but with a longer recovery period.
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Affiliation(s)
- B Lyons
- Department of Anaesthesia, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
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Abstract
We have compared the haemodynamic effects of ephedrine alone with ephedrine and colloid for the treatment of hypotension produced by subarachnoid anaesthesia in 30 patients aged 60-90 yr with fractures of the neck of femur. Group one received ephedrine as an initial bolus dose of 0.2 mg kg-1 followed by an infusion of 0.5 mg kg-1 h-1. Group two received ephedrine and colloid (polygeline, Haemaccel) 8 ml kg-1. If necessary, up to three rescue bolus doses of ephedrine (0.1 mg kg-1) and then colloid solution (8 ml kg-1) were given to maintain systolic arterial pressure (SAP) at > 75% of baseline. Arterial pressure was measured by automated oscillotonometry, central venous pressure (CVP) by a manometer and cardiac index (CI), stroke index (SI) and heart rate (HR) by transthoracic electrical bioimpedance. Systemic vascular resistance index (SVRI) was derived. In patients receiving ephedrine only, SVRI, CVP and SI decreased and HR increased (P < 0.0001). Five patients in this group required colloid, the effect of which was to restore CVP, increase CI and SI, and decrease HR (P < 0.02). In patients receiving ephedrine and colloid solution, SVRI decreased and CI, SI and HR increased (P < 0.0001). Ephedrine was not a potent arterial vasoconstrictor and SAP was maintained mainly by increases in SI and HR.
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Affiliation(s)
- L A Critchley
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin
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