Lene Nyhøj Heidemann

The relation between endometriosis and ovarian cancer - a review

Endometriosis is known to harbor characteristics substantiating its possible role as a precursor of ovarian cancer.

Barraquer-Simons syndrome: a unique patient's perspective on diagnosis, disease progression and recontouring treatment

This case report describes a female patient diagnosed with Barraquer-Simons syndrome, a rare form of acquired partial lipodystrophy characterised by symmetrical loss of adipose tissue from face, neck, upper extremities and the trunk with onset in early childhood. Initial symptoms were seen at the age of 8 years. Our patient did not show signs of renal impairment and this may be associated with the syndrome. Treatment of lipoatrophy in these patients is limited to cosmetic restoration, and autologous fat grafting has shown sustained positive effects with no or very little loss of volume at follow-ups. Furthermore, the treatment has resulted in considerable improvements in her quality of life and daily functioning. She has not experienced any adverse effects. Accurate and early diagnosis is important, and clinicians should consider early intervention for these patients. Autologous fat grafting is recommended as a safe procedure.

Vaginal vault recurrences of endometrial cancer in non-irradiated patients - Radiotherapy or surgery.

Background The treatment of locally recurrent endometrial cancer is based on limited evidence. The standard treatment is radiotherapy (RT) which is effective for local control and the effect has been documented in prospective studies. Investigations of surgical treatment (ST) of recurrences are few and limited to previously irradiated patients or patients with advanced disease. Investigation of surgical treatment for isolated vaginal vault recurrence is practically nonexistent. The aim of this study is to evaluate the efficacy of RT and ST in a non-irradiated group with recurrent endometrial cancer limited to the vaginal vault. Methods Patients treated for recurrent endometrial cancer at Odense University Hospital, Denmark between 2003 and 2012 were identified, n = 118. Thirty-three patients had an isolated vaginal vault recurrence and were treated with either RT, ST or both. Re-recurrence rates and survival rates were calculated at 2 year follow-up using Fishers exact test. Results Twenty-six patients were treated with RT, 5 with ST, 2 with both. The mean (SD) follow-up-time was 4.4 years (2.99) (RT) and 3.9 years (0.90) (ST). Two year re-recurrence rates were 40% (RT) (95 CI 9.2–48%) and 0% (ST) (95 CI 0–60%). Two-year survival rates were 83% (RT) (95 CI 71–100%) and 100% (ST) (95 CI 40–100%) ST had one re-recurrence at 2.3 years. Conclusion This study indicates that ST is an appropriate treatment for locally recurrent endometrial cancer. Our study involves a limited number of patients and is made retrospectively, therefore prospective and ideally randomized trials evaluating both survival and complications are warranted.

Four synchronous cancers in a patient with tongue pain as the only symptom

Synchronous carcinomas may be present in up to 6% of patients with head and neck squamous cell carcinoma (HNSCC) and thus may represent a significant factor in the disease burden. This case report illustrates the importance of a thorough examination of these patients. This patient presented with three synchronous squamous cell carcinomas, two in the tongue and one in the aryepiglottic fold. Positron emission tomography CT (PET-CT) was required for the detection of the carcinomas as the initial MRI and CT scans were inconclusive due to artefacts. Furthermore, PET-CT also revealed increased metabolic activity in the lymph nodes of the neck, which subsequently led to detection of a low-grade follicular lymphoma in addition to the squamous cell carcinomas. These findings support a generous use of PET-CT in patients with HNSCC, at least in those with obvious risk factors.

Nipple sparing mastectomy and the evolving direct to implant breast reconstruction

In this paper, we describe the evolving use of the nipple-sparing mastectomy (NSM) and direct to implant breast reconstruction according to existing literature and our own experience. The surgical method enables superior aesthetic results resembling that of a natural breast while maintaining oncologic safety. Acellular dermal matrix enables direct to implant breast reconstruction by serving as a hammock and can be used with acceptable rates of complications. A successful nipple-sparing mastectomy and direct to implant breast reconstruction approach with acceptable postoperative complication rates relies upon quality of the mastectomy skin flaps and correct patient selection. The surgical method has developed with a rapid pace and expected to evolve further in terms of technical modalities, safety measure and lasting results.

Prophylactic incisional negative pressure wound therapy reduces the risk of surgical site infection after caesarean section in obese women: a pragmatic randomised clinical trial

To evaluate the reduction of surgical site infections by prophylactic incisional negative pressure wound therapy compared with standard postoperative dressings in obese women giving birth by caesarean section.