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Current Opinion in Obstetrics & Gynecology

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https://www.readbyqxmd.com/read/29232258/development-and-history-of-morcellators
#1
Ceana Nezhat, Robert K Zurawin
PURPOSE OF REVIEW: Controversy exists surrounding extraction of tissue in gynecologic surgery using morcellators following cases of disseminated uterine cancers discovered after the use of electromechanical morcellators. This chapter traces the history of tissue extraction in gynecology and reviews the evolving scientific data and opinions regarding the future of morcellation. RECENT FINDINGS: Since the initial Food and Drug Administration warning about morcellation in 2014, subsequent studies do not support the Food and Drug Administration's high incidence of occult uterine cancer...
December 11, 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29232257/economics-of-gynecologic-morcellation
#2
Pietro Bortoletto, Jaclyn Friedman, Magdy P Milad
PURPOSE OF REVIEW: As the Food and Drug Administration raised concern over the power morcellator in 2014, the field has seen significant change, with patients and physicians questioning which procedure is safest and most cost-effective. The economic impact of these decisions is poorly understood. RECENT FINDINGS: Multiple new technologies have been developed to allow surgeons to continue to afford patients the many benefits of minimally invasive surgery while minimizing the risks of power morcellation...
December 11, 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29227303/alternative-facts-and-morcellation
#3
David L Olive
PURPOSE OF REVIEW: Since the recent black-box warning regarding the use of electromechanical morcellation, there has been a hesitancy to utilize the product and even to perform other types of morcellation by gynecologists. Unfortunately, this Food and Drug Administration action and the continued public criticisms of this procedure are grounded in poor data and faulty reasoning. To truly perform informed consent to patients considering procedures involving morcellation, a thorough review of the facts, not alternative facts, must be communicated...
December 8, 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29227302/the-target-invites-a-foe-antibody-drug-conjugates-in-gynecologic-oncology
#4
Maira P Campos, Gottfried E Konecny
PURPOSE OF REVIEW: Antibody-drug conjugates (ADCs) represent a promising new class of cancer therapeutics. Currently more than 60 ADCs are in clinical development, however, only very few trials focus on gynecologic malignancies. In this review, we summarize the most recent advances in ADC drug development with an emphasis on how this progress relates to patients diagnosed with gynecologic malignancies and breast cancer. RECENT FINDINGS: The cytotoxic payloads of the majority of the ADCs that are currently in clinical trials for gynecologic malignancies or breast cancer are auristatins (MMAE, MMAF), maytansinoids (DM1, DM4), calicheamicin, pyrrolobenzodiazepines and SN-38...
December 8, 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29227301/palliative-care-in-gynecologic-oncology
#5
Daniel Karlin, Peter Phung, Christopher Pietras
PURPOSE OF REVIEW: Patients with gynecologic malignancies face many difficult issues in the course of their diseases, ranging from physical symptoms to advance care planning in light of a poor prognosis. This review examines the evidence supporting integration of palliative care early in the course of disease and symptom management, and provides a framework for difficult conversations. RECENT FINDINGS: Palliative care has been demonstrated to improve quality of life and promote survival if integrated early in the course of disease...
December 8, 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29227304/cell-based-immunotherapy-in-gynecologic-malignancies
#6
Bruce Schaar, Venkatesh Krishnan, Supreeti Tallapragada, Oliver Dorigo
PURPOSE OF REVIEW: To provide an overview of the principles, safety and efficacy of adoptive cell therapy (ACT) in solid tumors particularly in gynecological cancers. RECENT FINDINGS: Efforts to target solid tumors using tumor-infiltrating lymphocytes and genetically modified T cells have shown promising efficacy in some patients. Two food and drug administration approvals for the treatment of leukemia are the first gene therapies available for cancer treatment in the United States...
December 7, 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29194077/advances-in-targeting-her2-positive-breast-cancer
#7
Nadia Harbeck
PURPOSE OF REVIEW: Breast cancer is the most common malignancy in women and HER2-positive disease comprises about 15% of all breast cancer cases. Over the last few years, substantial advances have been made in treatment of early breast cancer (EBC) and advanced (ABC) HER2-positive (HER2+) breast cancer. The present review summarizes the major publications on HER2+ breast cancer in the year 2017 and discusses their clinical relevance. RECENT FINDINGS: The clinically most relevant data in 2017 relates to the EBC setting...
November 30, 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29194076/morcellation-equipment-past-present-and-future
#8
Charles E Miller
PURPOSE OF REVIEW: This review was written in an effort to describe the evolution of power morcellation equipment from their creation to their current state. In addition, this review addresses the continuously evolving equipment involved with power morcellation and looks to describe where the field is headed in the future. In addition, recent professional and federal recommendations have changed the way power morcellation is being approached and has led to the development of contained morcellation systems, which, although in their infancy, are also being proven to be well tolerated options...
November 30, 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29176513/endocrine-therapy-in-ovarian-cancer-where-do-we-stand
#9
Laura Paleari, Andrea DeCensi
PURPOSE OF REVIEW: Hormonal factors play a pivotal role in epithelial ovarian tumorigenesis and steroid receptor expression has been associated with epithelial ovarian cancer (EOC) response and survival in recent studies. However, the degree of activity of endocrine therapy overall and by specific agents remains unclear. The purpose of this work is to summarize the evidence provided by the recent literature on the effectiveness of endocrine treatment for advanced EOC. RECENT FINDINGS: The results of 53 trials of different endocrine therapies in EOC indicate a clinical benefit of 41% [95% confidence interval (CI), 0...
November 14, 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28984646/first-trimester-prediction-and-prevention-of-adverse-pregnancy-outcomes-related-to-poor-placentation
#10
Arlene DʼSilva, Rina Fyfe, Jon Hyett
PURPOSE OF REVIEW: To summarize recent research findings related to first trimester prediction and prevention of adverse pregnancy outcomes associated with poor placentation. Recent publications related to prediction and prevention of preeclampsia, intrauterine growth restriction (IUGR) and stillbirth were reviewed. RECENT FINDINGS: Researchers continue to identify markers that will help predict pregnancies that go on to develop preeclampsia through screening at 11-13 weeks...
December 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28961633/cardiovascular-origins-of-preeclampsia
#11
Erkan Kalafat, Basky Thilaganathan
PURPOSE OF REVIEW: To review the current data on maternal cardiovascular adaptation in normal pregnancy and preeclampsia. RECENT FINDINGS: Defective placentation causes early-onset preeclampsia, a disease entity that is considered more or less distinct from late-onset preeclampsia. The latter has been attributed as 'maternal' preeclampsia. There are inconsistencies with the placental origins hypothesis, especially when considering the lack of a causative association with abnormal placental histology or impaired fetal growth...
December 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28961632/to-image-or-not-in-noncyclic-breast-pain-a-systematic-review
#12
Manuel Martín-Díaz, Marta Maes-Carballo, Khalid Saeed Khan, Aurora Bueno-Cavanillas
PURPOSE OF REVIEW: Investigation of noncyclic mastalgia in women without signs or risk factors for cancer is controversial. An initial imaging strategy can diagnose breast cancer early, potentially leading to better treatment and survival. However, cancer diagnosis is very uncommon in these cases, and this approach can be harmful, as false positives or suspicion results will lead to unneeded interventions and follow-up. The purpose of this review is to analyse the trade-offs between desirable and undesirable consequences of initial imaging tests against clinical follow-up...
December 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28961631/does-mindfulness-meditation-improve-chronic-pain-a-systematic-review
#13
Elizabeth F Ball, Emira Nur Shafina Muhammad Sharizan, Genny Franklin, Ewelina Rogozińska
PURPOSE OF REVIEW: Psychological factors are associated with chronic pain. Mindfulness meditation may ameliorate symptoms. The objective was to evaluate the effects of mindfulness meditation in chronic pain. RECENT FINDINGS: A systematic search of four databases identified 534 citations; 13 Randomised controlled trials satisfied the inclusion criteria. Mindfulness meditation significantly reduced depression [Standardised mean difference (SMD) -0.28; 95% confidence interval (CI) -0...
December 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28938376/updates-on-the-diagnostic-tools-for-evaluation-of-pelvic-floor-disorders
#14
Vivian C Aguilar, Amanda B White, Rebecca G Rogers
PURPOSE OF REVIEW: Pelvic floor disorders are common and cause significant morbidity for women. Recent advances in the evaluation of women with pelvic floor dysfunction have improved diagnostic accuracy and, with the development and use of validated patient-reported outcomes, has improved measurement of outcomes important to patients. We describe recent advances in the evaluation and measurement of pelvic floor disorders (PFDs). RECENT FINDINGS: We describe recent developments in pelvic floor assessment of women with pelvic floor dysfunction...
December 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28938375/difficult-implant-removals
#15
Amy Voedisch, Michele Hugin
PURPOSE OF REVIEW: Subdermal contraceptive implant insertions have rapidly increased worldwide. These devices are usually removed 3-5 years after insertion. Although removals are generally straightforward, difficult removals can occur. This review discusses the overall approach to potentially problematic removals and the appropriate steps to avoid complications and safely remove implants. RECENT FINDINGS: Given the rapid uptake of contraceptive implants and subsequent need for removals, an Implants Removal Task Force was formed to create standard protocols for difficult implant removals worldwide...
December 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28938374/contraceptive-counseling-for-continuation-and-satisfaction
#16
Gillian B Schivone, Laura L Glish
PURPOSE OF REVIEW: Quality contraceptive counseling has been identified as a potential means to reduce unintended pregnancy and to increase contraceptive continuation and satisfaction. Past approaches that focused on autonomous decision making and directive counseling have not been shown to meet these goals consistently. Women's health organizations globally are calling for improved counseling through more thorough discussion of side-effects and bleeding changes, and renewed focus on shared decision making and patient-centered care...
December 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28922193/update-on-second-trimester-medical-abortion
#17
Klaira Lerma, Kate A Shaw
PURPOSE OF REVIEW: To review recent literature on second trimester abortion with medical methods. RECENT FINDINGS: Across studies published in the recent past, it is apparent that women prefer shorter procedures and procedure times. Several randomized controlled trials have confirmed adding mifepristone to the second trimester medication abortion regimen results in shorter abortion intervals from first misoprostol administration to complete fetal expulsion. A study of simultaneous administration of mifepristone and misoprostol yielded shorter mean 'total' abortion times, presenting several logistical advantages...
December 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28915160/current-insights-in-obstetric-antiphospholipid-syndrome
#18
Karen Schreiber, Massimo Radin, Savino Sciascia
PURPOSE OF REVIEW: Antiphospholipid syndrome (APS) is defined as the association of thrombotic events and/or obstetric morbidity in patients persistently positive for antiphospholipid antibodies (aPL). In this review, we will highlight the most important clinical presentations of APS with a focus on the obstetric morbidity, the current management strategies and the outlook for the future. RECENT FINDINGS: The use of aspirin and heparin has improved the pregnancy outcome in obstetric APS and approximately 70% of pregnant women with APS have a successful pregnancy outcome...
December 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28915159/contraception-in-us-servicewomen-emerging-knowledge-considerations-and-needs
#19
Lauren A Harrington, Kate A Shaw, Jonathan G Shaw
PURPOSE OF REVIEW: We describe current literature regarding contraceptive use among women serving in the military. We explore the state of contraceptive use by female servicewomen, gaps in knowledge, special considerations, and evidence of unmet needs. RECENT FINDINGS: Recent data on US servicewomen show that overall rates of contraceptive use remain low. Data highlight disparities and suggest barriers to contraceptive uptake persist, with contraceptive use being lower around the time of deployment...
December 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28915158/simulation-training-for-family-planning-procedures
#20
Lisa M Goldthwaite, Kristina Tocce
PURPOSE OF REVIEW: To review the current evidence for use of simulation in family planning procedural training. RECENT FINDINGS: A variety of simulation models exist for abortion, contraception, and sterilization procedures, ranging from low to high fidelity. Most models for abortion and contraception are low fidelity, inexpensive, and provide opportunities for acquisition and practice of procedural skills. Hysteroscopic and laparoscopic simulation models for sterilization procedures are generally higher fidelity, and their use has been shown to increase knowledge, skill performance, and procedural comfort...
December 2017: Current Opinion in Obstetrics & Gynecology
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