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Over two thirds of ovarian cancer patients present with advanced stage disease at the time of diagnosis. In this scenario, standard treatment includes a combination of cytoreductive surgery and carboplatinum–paclitaxel-based chemotherapy. Despite the survival advantage of patients treated with upfront cytoreductive surgery compared to women undergoing neo-adjuvant chemotherapy (NACT) and interval debulking surgery (IDS) due to high tumor load or poor performance status has been demonstrated by multiple studies, this topic is still a matter of debate. As a consequence, selecting the adequate treatment through an appropriate diagnostic pathway represents a crucial step. Aiming to assess the likelihood of leaving no residual disease at the end of surgery, the role of the CT scan as a predictor of cytoreductive outcomes has shown controversial results. Similarly, CA 125 level as an expression of tumor load demonstrated limited applicability. On the contrary, laparoscopic assessment of disease distribution through a validated scoring system was able to identify, with the highest specificity, patients undergoing suboptimal cytoreduction and therefore best suitable for NACT-IDS. Against this background, with this article, we aim to provide a comprehensive review of available evidence on the diagnostic and treatment pathways of advanced ovarian cancer.

Cytoreductive surgery for recurrent abdominal endometrial cancer is typically performed by laparotomy.[1 2][1] Furthermore, thoracic procedures are usually performed with a thoracotomy approach. Recently, the uni-portal video-assisted thoracoscopic surgery (VATS) has been proposed as the new

Paraganglioma is one of the rarest neoplasms involving the ovary, with only 10 previous reports. We present a case of peritoneal carcinomatosis from primary ovarian paraganglioma and a systematic review of the literature. Clinical information was retrieved from medical records, and a systematic review of the literature was performed according to meta-analysis of observational studies in epidemiology guidelines. A 33-year-old woman presented with a 12-month history of hypertension and weight loss. She was diagnosed with ovarian paraganglioma and was treated with extensive debulking surgery to no residual disease after three cycles of neoadjuvant chemotherapy. She recurred after 6 months and was started on somatostatin-analogue. Following further disease progression with bone metastasis (treated with palliative radiotherapy), a trial with Sunitinib was started. The patient died 30 months after initial diagnosis. Of the cases reported to date, only one had peritoneal metastasis at presentation but none of them had such an ominous prognosis. Ovarian paraganglioma is an extremely rare condition. We report the first case of primary malignant ovarian paraganglioma with an exceptionally aggressive behavior. Clinicopathological correlation with immunohistochemistry is essential to avoid misdiagnosis. A standard treatment is not recommended yet but cytoreductive surgery seems to be a favorable approach to prolong survival.

A long-term debate concerns whether the sensorimotor coding carried out during transitive actions observation reflects the low-level movement implementation details or the movement goals. On the contrary, phonemes and emotional facial expressions are intransitive actions that do not fall into this debate. The investigation of phonemes discrimination has proven to be a good model to demonstrate that the sensorimotor system plays a role in understanding actions acoustically presented. In the present study, we adapted the experimental paradigms already used in phonemes discrimination during face posture manipulation, to the discrimination of emotional facial expressions. We submitted participants to a lower or to an upper face posture manipulation during the execution of a four alternative labelling task of pictures randomly taken from four morphed continua between two emotional facial expressions. The results showed that the implementation of low-level movement details influence the discrimination of ambiguous facial expressions differing for a specific involvement of those movement details. These findings indicate that facial expressions discrimination is a good model to test the role of the sensorimotor system in the perception of actions visually presented.

ObjectiveSplenectomy with or without distal pancreatectomy may be necessary at time of cytoreductive surgery to achieve complete cytoreduction in advanced ovarian cancer. However, these procedures have been associated with peri-operative morbidity. The aims of this study were to determine the incidence of distal pancreatectomy among patients undergoing splenectomy during cytoreductive surgery for advanced ovarian cancer and to determine the incidence, management, treatment, and prognosis of patients with post-operative pancreatic fistula.MethodsRetrospective cohort study of all consecutive patients with FIGO stage IIIC-IVB ovarian, fallopian tube, or primary peritoneal cancer who underwent splenectomy with or without distal pancreatectomy, during primary, interval, or secondary cytoreductive surgery between January 2007 and December 2017. All histologic subtypes were included; patients with borderline ovarian tumor and those undergoing emergency surgery were excluded from analysis. Univariate analyses for survival were generated by Kaplan–Meier survival curves and log-rank (Mantel–Cox) tests for statistical significance. Patients who underwent surgery for recurrence were excluded from survival analysis. Inter-group statistics were performed using Student’s t-test for continuous variables, and chi-square test and Fisher’s exact test for categorical variables.ResultsA total of 156/804 (19.4%) women underwent splenectomy, and of these 22 (14.1%) patients had distal pancreatectomy. Of patients who underwent splenectomy only, 2/134 (1.5%) developed grade B post-operative pancreatic fistula and 6/22 (27.3%) patients who underwent distal pancreatectomy developed grade B and C post-operative pancreatic fistula. Five (83.3%) of six of these patients were symptomatic. Distal pancreatectomy patients had a higher risk of developing post-operative pancreatic fistula when compared with patients who underwent splenectomy only (63.7% vs 9.7%, p=0.0001). Median length of hospital stay was longer in patients with post-operative pancreatic fistula: 16.5 (range 7–38) days compared with 10 (range 7–15) days (p=0.019). There was no progression-free survival (p=0.42) and disease-specific survival (p=0.33) difference between patients undergoing splenectomy with or without distal pancreatectomy.ConclusionClinically relevant post-operative pancreatic fistula is a relatively frequent complication (27.3%) following distal pancreatectomy and it is a possible complication after splenectomy only (1.5%).

ObjectiveAs an increasing number of patients with advanced/relapsed ovarian cancer need extensive cytoreductive procedures, there is an increasing number of complex cases collected in accredited tertiary cancer centers. With nosocomial infections and bacterial colonizations being a significant challenge in these patient cohorts, we aimed to evaluate the risk such infections pose to surgical outcome.MethodsProspective assessment of pathological bacterial colonization (vaginal, umbilical/groin, intraperitoneal, urine, oral/nose cavity) in patients who underwent open cytoreductive surgery for advanced/relapsed ovarian cancer in two large European tertiary referral centers for gynecologic malignancies. We recruited patients at initial diagnosis with International Federation of Gynecology and Obstetrics (FIGO) stage III and IV ovarian cancer and patients undergoing surgery for relapse. Swabs or cultures were taken from the following sites: vagina, groin and/or umbilicus, urine, intraperitoneal, mouth and/or nose. Only evidence of pathogenic bacteria was considered positive for bacterial colonization.ResultsA total of 172 primary advanced (70.9%) or relapsed (29.1%) ovarian cancer patients were included; 63.4% of them had received chemotherapy±additional targeted agents (16.3%) by the time of cytoreduction. 39.5% of the patients had a long-term vascular access line in situ. A bowel resection was performed in 44.8% and a splenectomy in 16.3% of the patients. Predefined surgical morbidity and mortality were 22.3% and 0%, respectively. Forty-one patients (23.8%) screened positive for pathogenic bacterial colonization with the presence of long-term intravenous access as the only independent risk factor identified (OR 2.34; 95% CI 1.05 to 5.34; p=0.04). Type of systemic treatments, previous bowel resections, previous hospitalizations, and patient demographics did not appear to significantly impact the risk of bacterial colonization. Furthermore, pathogenic bacterial colonization was shown to have no significant effect on peri-operative infection-related complications such as abscesses, wound infection, pneumonia, relaparotomy, or anastomotic leak.ConclusionsA total of 24% of patients undergoing cytoreductive surgery for ovarian cancer were confirmed positive for pathogenic bacterial colonization. The presence of long-term intravenous access was identified as the only significant risk factor for that, however the presence of pathogenic bacterial colonization per se did not seem to adversely affect outcome of cytoreductive effort or increase perioperative infection related complications.

The present study investigated whether 2-day-old newborns are able to discriminate two translating meaningless Point-Light Displays (PLD) videos, in which the shape of one of them changes compared to that of the other along the trajectory, independently from movement kinematics, and if this ability is present both when stimuli differed at the end or at the beginning of the movement. To manipulate the instant in which along the movement the difference between stimuli was evident, and to maintain every unspecific dissimilarity possibly determining the preference, videos were played in a loop either forward or backwards. In Experiment 1, PLD stimuli moved with natural accelerated-decelerated kinematics; in Experiment 2 they moved at constant velocity. Four groups of newborns were submitted to the preferential looking technique experiments. Results showed that newborns looked longer at natural kinematics and that, irrespective of the type of kinematics, they discriminated the two stimuli only when vid...

Gynaecological sarcomas account for 3-4% of all gynaecological malignancies and have a poorer prognosis compared to gynaecological carcinomas. Pivotal treatment for early-stage uterine sarcoma is represented by total hysterectomy. Whereas oophorectomy provides survival advantage in endometrial stromal sarcoma is still controversial. When the disease is confined to the uterus, systematic pelvic and para-aortic lymphadenectomy is not recommended. Removal of enlarged lymph-nodes is indicated in case of disseminated or recurrent disease, where debulking surgery is considered the standard of care. Fertility sparing surgery for uterine leiomyosarcoma is not supported by strong evidence, whilst available data on fertility sparing treatment for endometrial stromal sarcoma are more promising. For ovarian sarcomas, in the absence of specific data, it is reasonable to adapt recommendations existing for uterine sarcomas, also regarding the role of lymphadenectomy in both early and advanced stage disease. Specific recommendations on cervical sarcomas' surgery are lacking. Existing data on surgical approach vary from radical hysterectomy to fertility-preserving surgery in the form of trachelectomy or wide local excision, however no definite conclusions can be drafted on the recommended surgical approach. For vulval sarcomas, complete surgical excision with at least 2 cm of free margin is considered to be the primary treatment which is associated with good prognosis. The aim of this review is to provide highest quality evidence to guide gynaecologic oncologists throughout surgical management of gynaecological sarcomas.

Cervical cancer is still a major cause of morbidity and mortality in women. Early stages and locally advanced cervical cancer are currently treated respectively with surgery and chemoradiation with good prognosis. Persistent, recurrent and metastatic cervical cancers have a poor prognosis. Angiogenesis has been identified as a crucial factor for cervical cancer growth. Recently, research has increasingly focused on the development of targeted therapies, such as anti-angiogenic drugs. Amongst such drugs, bevacizumab, a recombinant humanized monoclonal antibody has been the subject of extensive investigation, including its use in cervical cancer. This was recently approved for the treatment of patients with metastatic, recurrent, or persistent cervical cancer.The aim of this review is to discuss the role of bevacizumab in both locally advanced and metastatic or recurrent cervical cancer and to analyze the studies that have led to the approval of bevacizumab in cervical cancer.The use of bevacizumab in combination with other chemotherapies in cervical cancer has been proven safe and effective, with a significant improvement in overall survival of patients with advanced cervical cancer. Combination therapy using bevacizumab has been demonstrated to increase toxicity rates but it does not impair patient's quality of life.

Objective To compare the usefulness of preoperative treatment with triptorelin, letrozole or ulipristal acetate or no treatment before hysteroscopic removal of uterine submucosal myomas. Study design Single center prospective non-randomized comparative pilot study. The study included consecutive premenopausal patients undergoing hysteroscopic resection of myomas graded as type 0, type 1 or type 2 according to the FIGO classification with diameter between 20 and 35mm. Exclusion criteria were: associated polyps, associated non-hysteroscopic surgical procedures, >2 myomas requiring hysteroscopic resection. This study enrolled patients who underwent either direct surgery (group S; n =23) or 3-month preoperative treatment with triptorelin (3.75mg every 28 days; group T; n =20), letrozole (2.5mg/day; group L; n =11) or ulipristal acetate (5mg/day; group U; n =7). Patients underwent hysteroscopic resection of the myomas. Results All medical treatments caused a significant decrease in the volume of myomas (group T, p p p =.006); however, the percentage decrease in myoma volume was lower in group U than in group T ( p =.001) and in group L ( p =.010). The hysteroscopy time was higher in group S than in group T ( p p =.001); there was no significant difference in the hysteroscopy time between group S and group U ( p =.206). Fluid absorption was lower in group T than in group S ( p =.002) and in group L than in group S ( p =.048); fluid absorption was similar in group S and group U ( p =.110). Intra- and postoperative complications, postoperative pain, and patient satisfaction were similar in the four study groups. Surgeon's evaluation of operative difficulty was better in group T than in group S ( p Conclusions Preoperative treatment with triptorelin and letrozole decreases the hysteroscopy time and the volume of fluid absorbed during hysteroscopic resection of uterine submucosal myomas.

Paraganglioma is one of the rarest neoplasms involving the ovary, with only 10 previous reports. We present a case of peritoneal carcinomatosis from primary ovarian paraganglioma and a systematic review of the literature. Clinical information was retrieved from medical records, and a systematic review of the literature was performed according to meta-analysis of observational studies in epidemiology guidelines. A 33-year-old woman presented with a 12-month history of hypertension and weight loss. She was diagnosed with ovarian paraganglioma and was treated with extensive debulking surgery to no residual disease after three cycles of neoadjuvant chemotherapy. She recurred after 6 months and was started on somatostatin-analogue. Following further disease progression with bone metastasis (treated with palliative radiotherapy), a trial with Sunitinib was started. The patient died 30 months after initial diagnosis. Of the cases reported to date, only one had peritoneal metastasis at presentation but none of them had such an ominous prognosis. Ovarian paraganglioma is an extremely rare condition. We report the first case of primary malignant ovarian paraganglioma with an exceptionally aggressive behavior. Clinicopathological correlation with immunohistochemistry is essential to avoid misdiagnosis. A standard treatment is not recommended yet but cytoreductive surgery seems to be a favorable approach to prolong survival.

Already in uterus the hand moves with the typical accelerated-decelerated kinematics of goal-directed actions and, from the twenty-second week of pregnancy, the unborn shows the ability to modulate the velocity of the movement depending on the nature of the target. According to the direct matching hypothesis, this motor knowledge may be sufficient to attune neonates' motion perception-like adults'-to biological kinematics. Using dots configuration motions which varied with respect to the kinematics of goal-directed actions, we observed that two-day-old human newborns did not show any spontaneous preference for either biological accelerated-decelerated motion or non-biological constant velocity motion when these were simultaneously presented in a standard preferential looking paradigm. In contrast, newborns preferred the biological kinematics after the repeated visual presentation of the different motions in a standard infant-control visual habituation paradigm. We propose that present results indicate that the relationship between perception and action does not require only action development but also the accumulation of sufficient perceptual experience. They also suggest a fast plasticity of the sensorimotor system in linking an already acquired motor knowledge with a newly experienced congruent visual stimulation.

While questionnaires are still the most common way to survey consumers’ behaviors, it is known that respondents’ answers can be affected by the social desirability attributed to the behavior under investigation. To check whether a social desirability bias also affects electricity consumption self-reports, a study was carried out adopting an explicit (questionnaire) and implicit measurement technique (the autobiographical Implicit Association Test). Three behaviors were probed in this way, with a sample of 180 participants (60 for each behavior). The analysis of the congruence between explicit and implicit answers confirms that desirability bias is at stake in self-reported measures of electricity conservation; it also shows that different behaviors—in this same domain—can be subject to this bias to a different extent and that a considerable amount of participants need to be considered as ambivalent. The methodological and conceptual implications of these findings and of the method are discussed with respect to pro-environmental studies and interventions.

This study investigated processing of number and extent in newborns. Using visual preference, we showed that newborns discriminated between small sets of dot collections relying solely on implicit numerical information when non-numerical continuous variables were strictly controlled (Experiment 1), and solely on continuous information when numerical variables were controlled (Experiment 2). When number and extent were pitted against each other (Experiment 3), newborns showed no visual preference, suggesting that the two variables play comparable roles in attracting newborns’ visual attention. In contrast to reports of dominance of continuous variables, these findings suggest that multiple dimensions attract newborns’ attention and guide their visual exploration.

Objectives The standard treatment for FIGO stage 1B1 cervical cancer is radical hysterectomy (RH) [1]. Indocyanine-green (ICG) is a drug injected within the cervical stroma to detect the sentinel lymph node (SLN) in cervical cancer [2,3]. ICG travels through the lymphatic channels in the lateral parametrium, which results enhanced with green, before reaching the SLNs. This could help identifying the surgical landmarks. The aim of this video is to propose a new approach to perform parametrial dissection as part of RH under the guidance of ICG. Methods The patient was a 49-years old woman diagnosed with a FIGO 1B1 moderately-differentiated cervical squamous cell carcinoma. No evidence of lymphoadenopathy on pre-operative imaging. 0.25ml of ICG (1.25mg/ml) were injected superficially and deep at 3 and 9 o'clock in the cervix as first step of the operation. Bilateral SLN biopsy followed by type C1 RH with bilateral salpingo-oophorectomy and bilateral pelvic node dissection was performed. Near-infrared camera (PINPOINT® - Novadaq Technologies) was used during parametrial dissection. Results ICG was used as a guide to demarcate the parametrial tissue and assist the dissection of the lateral (paracervix) and anterior (vesico-uterine ligament) parametrium off the surrounding structures (bladder and ureter). Operation time was 150min and intraoperative estimated blood loss was 50 mls. No intraoperative or postoperative complication was reported. Conclusions ICG-assisted parametrial dissection during RH after SLN biopsy in early stage cervical cancer can be a useful tool to guide the surgeon to perform the procedure and potentially improve surgical outcomes.

The primary objective of this prospective comparative nonrandomized study was to assess the feasibility and safety of intraoperative transrectal ultrasonography (TRUS) during hysteroscopic metroplasty (HM). The secondary objective of the study was to assess whether TRUS facilitates complete removal of the uterine septum. Septate uterus was diagnosed by 3-dimensional transvaginal ultrasonography (3D-TVS) and confirmed by magnetic resonance imaging. In the control group (HM group; n = 18), patients underwent HM according to the traditional standard of operative hysteroscopy. In the study group (HM+TRUS group; n = 27), HM and TRUS were performed simultaneously; the hysteroscopic procedure was continued until a normal uterine fundus was observed. At 6 to 8 weeks after HM, 3D-TVS was performed to identify the numbers of complete resections (residual septum absent or5 mm), suboptimal resections (residual septum 5-10 mm), and incomplete resections (residual septum10 mm). The 2 study groups did not differ significantly in terms of demographic and clinical characteristics, or in the volume of fluid infused and absorbed. There were no severe intraoperative or postoperative complication in either group; 2 patients in the HM+TRUS group and 1 patient in the HM group experienced urinary tract infection (p = .807). At 6 to 8 weeks after HM, the number of suboptimal resections and incomplete resections was higher in the HM group than in the HM+TRUS group (p = .031). Residual septum10 mm (incomplete resection) was seen in 1 patient in the HM group but in no patients in the HM+TRUS group. Intraoperative TRUS can be performed safely during HM, and may increase the likelihood of complete resection of the uterine septum; however, this finding should be confirmed by larger studies.

Dienogest (DNG) is an oral progestin, derivative of 19-nortestosterone, that has recently been introduced for the treatment of endometriosis.This review examines the clinical efficacy, safety and tolerability of DNG in the treatment of endometriosis. The material included in the current manuscript was searched and obtained via Medline, Pubmed and EMBASE, from inception until February 2014. The term 'dienogest' was associated with the following search terms: 'endometriosis', 'pharmacokinetics', 'safety' and 'efficacy'.Several trials demonstrated the clinical efficacy, safety and tolerability of DNG. However the use of DNG is associated with some limitations. So far, no study investigated the potential of contraceptive effect of this treatment and therefore, it should be recommended with other methods of contraception (e.g., barrier methods). A further limitation of the use of DNG as daily therapy in the long term is that the cost of the therapy is higher than other progestins available on the market and combined oral contraceptives. Therefore, future studies should be designed to compare the efficacy and safety of DNG with other progestins.

Autobiographical memories might be identified using a variant of the implicit association test (IAT), or the autobiographical IAT (aIAT). The aIAT provides a measure of association between true sentences and sentences describing an autobiographical event. This tool might be used to evaluate whether specific autobiographical information is encoded within the respondent's mind/brain. This paper examines possible problems arising when the aIAT is used as a lie-detector technique. The results indicate that, when given previous instruction or training with an aIAT, examinees can alter their results and beat the ‘memory-detector’. However, we have been able to detect successful fakers of aIAT on the basis of their specific response patterns. Our algorithm has the ability to spot the faker in a satisfactory manner. If, as demonstrated here, faking can be detected, then the real autobiographical event might also be identified when the examinee attempts to alter their results. Copyright © 2010 John Wiley & Sons, Ltd.