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Objective: Cancer patients are at risk for developing venous thromboembolism (VTE). The present authors assessed the value of using thrombelastography (TEG) to evaluate the coagulation state of women with various forms of gynecological disorders. Materials and Methods: Surgical patients with gynecological malignancy (study group, n = 65, 71%) were prospectively compared to patients with premalignant and benign disease (control group, n = 19, 29%). Routine blood tests and TEG results were collected one day prior to surgery. Clinical and laboratory data were collected from the medical charts. Univariate and multivariate analyses were performed to determine group differences. Results: The study patients included 15 (23%) women with endometrial, 22 (33.8%) with ovarian, and nine (13.8%) with uterine cervical cancer. They were significantly older, had a higher body mass index, and more comorbidities, all known risk factors to develop VTE, compared to the control group. Surprisingly, TEG parameters were similar for both groups except for the α angle (time of clot formation), that was wider in the study group (76.6 ± 3.43º vs. 74.66 ± 3.66º, p = 0.044, non-significant on multivariate analysis). Conclusions: The pre-surgical/basal TEG profile is similar for gynecological patients with malignant and benign disease and therefore does not differentiate between them in terms of greater risk of VTE. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the accuracy, safety, and outcome of sentinel lymph node biopsy (SLNB) in early-stage vulvar cancer and determine the applicability of this procedure for selected patients in Israel. Materials and Methods: Forty-five patients with T1 squamous cell carcinoma (SCC) of the vulva who underwent surgery with SLNB between 2002-2011 were included. SLN was detected using both radioactive tracer and blue dye. All resected nodes underwent pathological examination. The accuracy, recurrence rates, and complications of the procedure were analyzed. Results: There was a significant correlation between radioactive reading intensity and SLN detection in frozen section (p < 0.0003, p < 0.0001). A weaker correlation existed with use of blue dye (p = 0.04, p = 0.09). For metastatic LNs, the detection rates of both agents were similar. The false negative for metastatic SLN detection in frozen section was 12.5%, while the false positive was 2%. The rate of inguinal recurrence without local recurrence was 4.4%. For patients with unifocal vulvar disease and a negative sentinel node the seven-year survival rate was 94%. Conclusion: SLNB is an effective and safe procedure for Israeli patients with earlystage SCC of the vulva. Recurrence rates and disease-free survival are similar to the reported literature and morbidity is low compared to radical inguinal LNs resection. [ABSTRACT FROM AUTHOR]

Objective: To describe the implementation of robotic radical trachelectomy with sentinel lymph node mapping utilizing indocyanine green (ICG) in patients with early cervical cancer. Materials and Methods: This retrospective analysis studied six cases of robotic assisted laparoscopy with the use of the da Vinci-Firefly fluorescence imaging to detect sentinel lymph nodes. Results: Six patients with cervical cancer clinical Stages IA2 to IB1were included. All patients underwent fertility preserving surgery in which complete tumor resection with free pathological margins was confirmed by final pathology (including an obese patient with a BMI of > 40). There were no major surgical complications. Conclusion: Robotic radical trachelectomy with sentinel lymph node mapping using ICG is an effective and safe method to treat early cervical cancer. [ABSTRACT FROM AUTHOR]

The article presents a study which assesses the correlation between positive cancer-focused cancer risk evaluation and early detection (CADET) scores and abnormal ultrasonographic ovarian findings to establish the usefulness of the CADET scores as ovarian cancer screening tool. Women who were referred for pelvic transvaginal ultrasonograhic examination comprised the study group. It was observed in the study that CADET scores did not correlated with abnormal ultrasonography results.

Objective: Our purpose was to increase the number of the progenitor cells in umbilical cord blood collected for transplantation.Study Design: We randomly assessed the effect of "upper" and "lower" positions of the newborn on the volume and progenitor cell (CD34(+)) content of the umbilical cord blood collected from 49 healthy, vaginally delivered, term neonates.Results: Twenty-two collections were performed in the "upper" and 27 in the "lower" position. The volume of umbilical cord blood obtained in the "upper" position was 108.1 +/- 19.1 mL compared with 42.6 +/- 19.5 mL in the "lower" position (P <.0001). Mononuclear cell separation revealed significantly higher numbers of cells in umbilical cord blood obtained in the "upper" group (P <.01). Although the percentage of CD34(+) cells was comparable, the absolute number of CD34(+) cells was significantly higher in the "upper" group because of the larger volume collected (P <.02). At 24 hours after delivery the hemoglobin levels were not significantly different between newborns of the 2 groups.Conclusions: Placing the newborn on the maternal abdomen after delivery and before cord clamping may significantly increase the volume of umbilical cord blood collected and therefore the CD34(+) counts that improve transplantation success without placing the mother or the newborn at risk. [ABSTRACT FROM AUTHOR]

Objective: Erythromycin is a stimulant of motor activity in the stomach, but its effects on the uterus have not been studied and only its antibiotic properties have been considered in the treatment of idiopathic preterm labor. The objective of this study was to characterize in vitro the effect of erythromycin on the contractility of the pregnant rat uterus.Study Design: Myometrial strips from pregnant rats were suspended in tissue baths Isometric contractions were monitored by force transducers in response to various agents that were added to the bath solution.Results: Erythromycin exposure caused a sustained decrease in phasic contractions induced by oxytocin or carbachol. This effect started at 0.01 mmol/L. At 1 mmol/L erythromycin reduced the contractions amplitude to 22% of the control and the frequency was reduced to 38% of control.Conclusion: We conclude that erythromycin produces a decrease in the pregnant rat myometrial activity in vitro, independent of the stimulant. [ABSTRACT FROM AUTHOR]

Objective: Our purpose was to determine whether red blood cells from patients with severe preeclampsia may exhibit increased membrane exposure of procoagulant phospholipids (i.e., phosphatidylserine), which may initiate intravascular clotting and platelet activation.Study Design: The study group comprised 28 women: 9 with severe preeclampsia in the third trimester of pregnancy, 10 normotensive with uncomplicated pregnancies, and 9 age-matched, nonpregnant, healthy women. The exposure of phosphatidylserine on the outer membrane phospholipid layer was analyzed with use of isolated, washed red blood cells that were added as a source of phospholipids to a "prothrombinase" coagulation complex.Results: The resultant thrombin formed was measured by an amidolytic assay. Thrombin generation significantly increased on the addition of red blood cells from women with preeclampsia (741 +/- 132 mU/ml/min) compared with red blood cells from normotensive pregnant (422 +/- 228 mU/ml/min) and nonpregnant women (316 +/- 268 mU/ml/min, p = 0.0008).Conclusion: This study indicates that in patients with preeclampsia the red blood cells exhibit a significant procoagulant surface that may trigger thrombin formation, thereby playing a role in the hypercoagulable state. [ABSTRACT FROM AUTHOR]

BACKGROUND: Trophoblastic tissue spread following uterine perforation during dilation and curettage is rare. We present a case of trophoblastic spread to the sigmoid colon following uterine perforation, which was treated by surgical removal of the implants and intramuscular administration of methotrexate. CASE: A woman presented 3 weeks after curettage for a blighted ovum. Laparotomy performed for suspected intra-abdominal bleeding revealed bleeding trophoblastic implants in a perforation tract and the anterior uterine wall and on the appendix epiploica of the sigmoid colon. The implants were surgically removed and methotrexate was administered for persistently high beta-hCG levels. The patient fully recovered. CONCLUSION: Extrauterine trophoblastic implants should be considered in women evaluated for abdominal pain whose pregnancy test is positive after uterine perforation. Conservative treatment with methotrexate in nonacute patients may be considered. [ABSTRACT FROM AUTHOR]