This review article discusses the role of the general surgeon in interdisciplinary gynecologic cancer from these two perspectives. The skill of the general surgeon is a useful part of the interdisciplinary management of these patients.
Intrapartum application of the continuous glucose monitoring system in pregnancies complicated with
Abstract
MINIREVIEW
INTRODUCTION
SIGNIFICANCE OF INTRAPARTUM NORMOGLYCEMIA
INTRAPARTUM GLUCOSE MONITORING PROTOCOLS
CLINICAL INDICATION OF CGMS USE
The indications and consequences of the use of CGMS in the peripartum and intrapartum environment have not been evaluated and therefore need to be evaluated.
USE OF CGMS IN PREGNANCY
INTRAPARTUM APPLICATION OF CGMS
CONCLUSION
Blood glucose control during labor in diabetic women with combined glucose and low-dose insulin infusion. A standardized protocol for achieving normoglycemia during labor and delivery in women with type 1 diabetes. Evaluation of a new insulinotropic agent using an innovative technology: efficacy and safety of nateglinide determined by continuous glucose monitoring.
Day-to-day glucose variability during pregnancy in women with type 1 diabetes mellitus: glucose profiles measured with the continuous glucose monitoring system. Forty-eight hour first trimester glucose profiles in women with type 1 diabetes mellitus: a report of three cases of congenital malformation. Continuous subcutaneous glucose monitoring system in diabetic mothers during labor and postnatal glucose adjustment of their infants.
Intrapartum application of the Continuous Glucose Monitoring System in pregnancies complicated by diabetes.
Laparoscopic surgical repair of pelvic organ prolapse and female stress urinary incontinence
Mourmouris, Andreas Skolarikos, Iraklis C Mitsogiannis, Vasileios Migdalis, Athanasios G Papatsoris
The decision on the type of operation depends on the spaces affected and the characteristics of the patient. The laparoscopic approach to surgical treatment of POP was introduced to treat the three compartment defects with the aim of being less invasive than open surgery, easier enlarged access to the pelvis with less blood, and shorter postoperative convalescence. We performed a search of the PubMed and Cochrane databases for articles on surgical repair of POP and laparoscopic approaches published between 1970 and 2013.
We reviewed all relevant articles and analyzed those with the largest series.
LAPAROSCOPIC RETROPUBIC SUSPENSION
LAPAROSCOPIC PROMONTOFIXATION
LAPAROSCOPIC PLACEMENT OF THE ARTIFICIAL URINARY SPHINCTER FOR
The age of the patients was between 50 and 79 years, while the same surgeon performed all the procedures. The first step was an anterior approach to the bladder followed by dissection of the periurethral fascia and bladder neck from the vagina. The next step was dissection of the bladder neck below the periurethral fascia and the cuff was positioned and pressurized.
The balloon was introduced through the iliac fossa mini incision and placed to the right of the bladder, and then the pump was placed in the labia major. The next step was incision of the peritoneum and dissection of the lateral attachments of the bladder neck. Next was dissection of the urethra from the vaginal wall and placement of the AUS measuring tape and cuff.
After placement of the cuff around the urethra, the AUS balloon reservoir with the relevant volume of fluid was inserted.
LAPAROSCOPIC AND ROBOTIC ASSISTED LAPAROSCOPIC SACROCOLPOPEXY
Complete laparoscopic treatment of genital prolapse with mesh, including vaginal promontofixation and anterior repair: a series of 138 patients. The use of an artificial urinary sphincter in women with type III incontinence and a negative Marshall test. Laparoscopic approach for artificial urinary sphincter implantation in women with intrinsic sphincter deficiency incontinence: a single center preliminary experience.
Laparoscopic artificial implantation of the urinary sphincter for true stress urinary incontinence in women: technique and 4 years of experience in 25 patients. Risk of mesh extrusion and other mesh-related complications after laparoscopic sacral colpopexy with or without concurrent laparoscopic-assisted vaginal hysterectomy: experience of 402 patients. Long-term outcomes of robot-assisted laparoscopic sacrocolpopexy for the treatment of high-grade vaginal prolapse.
Smoking and genital human papillomavirus infection in women attending cervical cancer screening in Greece.
Smoking and genital human papilloma virus infection in women attending cervical cancer screening in Greece
BRIEF ARTICLE
We investigated whether smoking can influence the course of an HPV infection in 1291 women who attended cervical cancer screening. Smoking and genital human papillomavirus infection among women undergoing cervical cancer screening in Greece. Specific types of hrHPV can cause cervical cancer, and more than 95% of cervical cancer biopsies contain DNA from hrHPV genomes[2].
However, there are several other factors that may affect the probability of hrHPV infection or accelerate the carcinogenic processes leading to cervical cancer[3]. Many studies have shown that smoking and smoking in general have a moderate and statistically significant association with cervical cancer and cervical intraepithelial neoplasia (CIN)[10-19], although the latter is not supported by other studies[20] . However, it is not clear enough whether smoking, in addition to increasing the risk of invasive cervical cancer and its precursors, may also affect HPV infection, especially persistent HPV infection.
In this study, this possible association has been investigated in an urban population of women participating in cervical cancer screening in Greece.
MATERIALS AND METHODS
Smoking appears to be associated with high-risk cervical HPV (hrHPV) infection, particularly in younger women aged 25 to 34 years. In general, HPV is divided into two groups based on oncogenic potential: the first group consists of the so-called low-risk and the second high-risk HPV types (hrHPV). Recent research focusing on the possible association between tobacco smoking and HPV infection has shown a positive association in both women and men [26].
Specifically, the Cobas® 4800 HPV test uses primers to determine a sequence of approximately 200 nucleotides within the polymorphic L1 region of the HPV genome. Simultaneous infusion, enhancement and detection of the human β-globulin genome and viral sequences using the Cobas® 4800 HPV test gives the user the added benefit of control during all stages of the study. The association between HPV infection and smoking was evaluated using the χ2 test and Fisher's exact test.
Frequencies and relative frequencies and their corresponding P-values for the χ2 test and the ORs are calculated.
RESULTS
The influence of smoking and smoking intensity on hrHPV infection as well as on cytology status was evaluated using cross-tabulation matrices associating age. The latter is defined according to the calculated smoking intensity index (SII = cigarettes/d × 365 × years of smoking divided by 1000), and a woman is classified as a non-smoker if she has never smoked or if she has stopped smoking. at least 1 year earlier. There was no statistically significant association between smoking habits (ie smokers vs non-smokers) or smoking intensity (increasing SII) and infection of HPV types 16 or 18 in any age group.
Comparisons according to smoking habits (smokers vs non-smokers) or smoking intensity between women with normal and women with abnormal cytology results, using the χ2 test, showed no statistically significant differences between different age groups (data not shown). Smoking, HPV status and cervical cytology results Comparisons according to smoking habits between the two groups of women regarding cervical cytology and the two groups regarding hrHPV status showed that women with a negative Pap test were more likely to have hrHPV - infection if they were smokers than if they had There was no statistically significant relationship between smoking intensity and (h) human papillomavirus (HPV) status.
On the other hand, similar comparisons of smoking intensity between the two groups of women for cervical cytology and the two groups for hrHPV status based on very low numbers showed that smoking intensity (increasing SII) was associated with a higher probability of being positive (P = 0.045), but not a negative Pap test (Table 5).
DISCUSSION
Therefore, studies evaluating risk factors for HPV infection should be conducted in different locations around the world. This finding may suggest that smoking may increase HPV infection at early stages, before preinvasive lesions develop. The persistence of HPV infection may have increased, leading to an increased risk of progression to cancer, along with the carcinogenic effect of polycyclic aromatic hydrocarbons contained in tobacco smoke[21].
On the other hand, the persistence of HPV infection and the progression to high-grade lesions are probably facilitated by smoking, due to a local immunosuppression it causes[21,38,43]. Furthermore, smoking appears to reduce the ability of the immune system to develop HPV-16/18 antibodies or to maintain HPV-16/18 antibody positivity over time after a natural HPV infection[46]. Consecutive HPV genotyping of all participants, at certain intervals, may indicate whether smoking may also influence the course of HPV infection.
In any case, current smokers with HPV infection or with a CIN lesion should be managed carefully and should be advised to quit smoking.
COMMENTS
Risk of grade 3 or worse cervical intraepithelial neoplasia in relation to smoking in women with persistent human papillomavirus infection. Smoking and tobacco chewing as risk factors for multiple human papillomavirus infections and cervical squamous intraepithelial lesions in two countries (Côte d'Ivoire and Finland) with different tobacco exposure. Smoking is an independent risk factor for oncogenic human papillomavirus (HPV) infections but not for high-grade CIN.
Smoking increases the risk of high-grade vaginal intraepithelial neoplasia in women with oncogenic human papillomavirus. Smoking and human papillomavirus infection: pooled analysis of the International Agency for Research on Cancer HPV prevalence studies. Risk factors for cervical human papillomavirus infection and high-grade intraepithelial lesion in women aged 20 to 31 years in Germany.
Synergy between cigarette smoking and human papillomavirus type 16 in the development of cervical cancer in situ.
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MANUSCRIPTS